Neutrophil-lymphocyte ratio is prognostic in early stage resected small-cell lung cancer

Zoltan Lohinai; Laura Bonanno; Aleksei Aksarin; Alberto Pavan; Zsolt Megyesfalvi; Balazs Santa; Virag Hollosi; Balazs Hegedus; Judit Moldvay; PierFranco Conte; Mikhail Ter-Ovanesov; Evgeniy Bilan; Balazs Dome; Glen J Weiss

doi:10.7717/peerj.7232

Neutrophil-lymphocyte ratio is prognostic in early stage resected small-cell lung cancer

PeerJ. 2019 Jul 29:7:e7232. doi: 10.7717/peerj.7232. eCollection 2019.

Authors

Zoltan Lohinai^{1

2}, Laura Bonanno³, Aleksei Aksarin⁴, Alberto Pavan³, Zsolt Megyesfalvi^{1

2}, Balazs Santa¹, Virag Hollosi¹, Balazs Hegedus⁵, Judit Moldvay¹, PierFranco Conte⁶, Mikhail Ter-Ovanesov⁷, Evgeniy Bilan⁸, Balazs Dome^{1

2

9}, Glen J Weiss¹⁰

Affiliations

¹ National Koranyi Institute of Pulmonology, Budapest, Hungary.
² Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.
³ Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy.
⁴ Surgut District Clinical Hospital, Surgut, Russia.
⁵ Department of Thoracic Surgery, University Hospital Essen, Essen, Germany.
⁶ Department of Surgical, Oncological and Gastroenterological Sciences, Università degli Studi di Padova, Padova, Italy.
⁷ Peoples' Friendship University of Russia, Moscow, Russia.
⁸ Department of Oncology, Surgut District Clinical Hospital, Surgut, Russia.
⁹ Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
¹⁰ Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.

Abstract

Background: For selected early stage small cell lung cancer (SCLC), curative intent surgery is often performed. Previous studies, predominantly from East Asia, reported that high neutrophil to lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) correlate with poor prognosis in several types of tumors including SCLC. Our aim was to investigate the prognostic value of NLR and PLR in Caucasian patients with resected SCLC, as potential tool to select patients for multimodal treatment including surgery.

Methods: Consecutive patients evaluated at three centers between 2000 and 2013 with histologically confirmed and surgically resected SCLC were retrospectively analyzed. NLR and PLR at diagnosis was used to categorize patients into "high" and "low" groups based on receiver operating curve analysis. Univariate and multivariate analyses were used to evaluate the impact of clinical and pathological characteristics on outcome.

Results: There were a total of 189 patients with a median age of 58 years, and the majority had stage I or II disease. We found a significant correlation between NLR and tumor stage (p = 0.007) and age (p = 0.038). Low NLR (LNLR) was associated with significantly longer overall survival, while PLR had no prognostic impact. There were significant associations between NLR and PLR but not with gender, vascular involvement, tumor necrosis, peritumoral inflammation, or tumor grade.

Conclusion: Pre-operative LNLR may be a favorable prognostic factor in stage I-II SCLCs. PLR is not prognostic in this population. LNLR is easy to assess and can be integrated into routine clinical practice. Further prospective studies are needed to confirm these observations.

Keywords: Early stage small cell lung cancer; Neutrophil–lymphocyte ratio; Platelet–lymphocyte ratio; Surgery.

Grants and funding

Zoltan Lohinai was supported by the ESMO Translational Research Fellowship, the 2018 LCFA-BMS/IASLC Young Investigator Scholarship Award, and the Hungarian Scientific Research Fund (OTKA #124652 and OTKA #129664). Zsolt Megyesfalvi and Balazs Santa received support from the Hungarian Scientific Research project (EFOP-3.6.3-VEKOP-16-2017-00009). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.