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      Prognostic significance of neutrophil-to-lymphocyte ratio in non-small cell lung cancer: a meta-analysis

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          Abstract

          Published data on the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in non-small cell lung cancer (NSCLC) are controversial. We performed a meta-analysis to more accurately assess its prognostic value. The analysis was performed based on the data from 14 studies with 3,656 patients to estimate the correlation between NLR and overall survival (OS) and progression-free survival (PFS) in NSCLC. Hazard ratio (HR) with 95% confidence interval (CI) were calculated to estimate the effect. We also conducted subgroup analysis and meta-regression analysis. The results demonstrated that elevated pretreatment NLR predicted poorer OS (HR: 1.70, 95% CI: 1.39–2.09) and PFS (HR: 1.63, 95% CI: 1.27–2.09) in patients with NSCLC. Subgroup analysis indicated that cut-off value of 5 showed consistently prognostic value. There was no significant heterogeneity or publication bias for OS and PFS for included studies. This meta-analysis revealed that elevated pretreatment NLR might be a predicative factor of poor prognosis for NSCLC patients.

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          The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer.

          Donald C. McMillan (2013)
          Since the initial work, a decade ago that the combination of C-reactive protein and albumin, the Glasgow Prognostic Score (GPS), had independent prognostic value in patients with cancer, there have been more than 60 studies (>30,000 patients) that have examined and validated the use of the GPS or the modified GPS (mGPS) in a variety of cancer scenarios. The present review provides a concise overview of these studies and comments on the current and future clinical utility of this simple objective systemic inflammation-based score. The GPS/mGPS had independent prognostic value in (a) unselected cohorts (4 studies, >19,400 patients) (b) operable disease (28 studies, >8,000 patients) (c) chemo/radiotherapy (11 studies, >1500 patients) (d) inoperable disease (11 studies, >2,000 patients). Association studies (15 studies, >2,000 patients) pointed to an increased GPS/mGPS being associated with increased weight and muscle loss, poor performance status, increased comorbidity, increased pro-inflammatory and angiogenic cytokines and complications on treatment. These studies have originated from 13 different countries, in particular the UK and Japan. A chronic systemic inflammatory response, as evidenced by the GPS/mGPS, is clearly implicated in the prognosis of patients with cancer in a variety of clinical scenarios. The GPS/mGPS is the most extensively validated of the systemic inflammation-based prognostic scores and therefore may be used in the routine clinical assessment of patients with cancer. It not only identifies patients at risk but also provides a well defined therapeutic target for future clinical trials. It remains to be determined whether the GPS has prognostic value in other disease states. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients

            S Krenn-Pilko, U Langsenlehner, E-M Thurner … (2014)
            Background: The elevation of the platelet-to-lymphocyte ratio (PLR), an easily applicable blood test based on platelet and lymphocyte counts has been associated with poor prognosis in patients with different types of cancer. The present study was aimed to investigate the prognostic significance of the preoperative PLR in a large cohort of breast cancer patients. Methods: Data from 793 consecutive non-metastatic breast cancer patients, treated between 1999 and 2004, were evaluated retrospectively. The optimal cutoff values for the PLR were calculated using receiver operating curve analysis. Cancer-specific survival (CSS), overall survival (OS) as well as distant metastasis-free survival (DMFS) were assessed using the Kaplan–Meier method. To evaluate the independent prognostic significance of PLR, multivariable Cox regression models were applied for all three different end points. Results: Univariable analysis revealed a significant association between the elevated preoperative PLR and CSS (hazard ratio (HR): 2.75, 95% confidence interval (CI): 1.57–4.83, P<0.001) that remained statistically significant in multivariable analysis (HR: 2.03, 95% CI: 1.03–4.02, P=0.042). An increased PLR was also significantly associated with decreased OS in univariable (HR: 2.45, 95% CI: 1.43–4.20, P=0.001) and in multivariable analysis (HR: 1.92, 95% CI: 1.01–3.67, P=0.047). Furthermore, univariable analysis showed a significant impact of increased PLR on DMFS (HR: 2.02, 95% CI: 1.18–3.44, P=0.010). Subgroup analysis revealed significant associations of the elevated PLR on the primary end point CSS for all breast cancer subtypes. This association retained its significance in multivariable analysis in patients with luminal B tumours (HR: 2.538, 95% CI: 1.043–6.177, P=0.040). Conclusions: In this study, we identified the preoperative PLR as an independent prognostic marker for survival in breast cancer patients. Independent validation of our findings is needed.
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              Pretreatment neutrophil count as an independent prognostic factor in advanced non-small-cell lung cancer: an analysis of Japan Multinational Trial Organisation LC00-03.

              Satoshi Teramukai, Toshiyuki Kitano, Yusuke Kishida … (2009)
              We examined the impact of pretreatment neutrophil count on survival in patients with advanced non-small-cell lung cancer (NSCLC). A total of 388 chemo-naïve patients with stage IIIB or IV NSCLC from a randomised controlled trial were evaluated. The effects of pretreatment peripheral blood neutrophil, lymphocyte and monocyte counts and neutrophil-lymphocyte ratio on survival were examined using the proportional hazards regression model to estimate hazard ratios after adjustment for covariates. The optimal cut-off value was determined by proportional hazards regression analysis with the minimum P-value approach and shrinkage procedure. After adjustment for prognostic factors, the pretreatment elevated neutrophil count was statistically significantly associated with short overall (P=0.0008) and progression-free survival (P=0.024), whereas no association was found between prognosis and lymphocyte or monocyte count. The cut-off value selected for neutrophil count was 4500 mm(-3) (corrected hazard ratio, 1.67; 95% confidence interval (CI), 1.09-2.54). The median survival time was 19.3 months (95%CI, 16.5-21.4) for the low-neutrophil group (4500 mm(-3), n=204) and was 10.2 months (95%CI, 8.0-12.3) for the high-neutrophil group (4500 mm(-3), n=184). We confirmed that pretreatment elevated neutrophil count is an independent prognostic factor in patients with advanced NSCLC receiving modern chemotherapy. Neutrophil count is easily measured at low cost, and it may be a useful indicator of patient prognosis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Sci Rep
                Journal ID (iso-abbrev): Sci Rep
                Title: Scientific Reports
                Publisher: Nature Publishing Group
                ISSN (Electronic): 2045-2322
                Publication date (Electronic): 24 July 2015
                Publication date Collection: 2015
                Volume: 5
                Electronic Location Identifier: 12493
                Affiliations
                [1 ]Cancer Center, Chinese PLA General Hospital and Chinese PLA Medical School , Beijing, China
                [2 ]Nanlou Department of Respiratory Disease, Chinese PLA General Hospital and Chinese PLA Medical School , Beijing, China
                Author notes
                [*]

                These authors contributed equally to this work.

                Article
                Publisher Item ID: srep12493
                DOI: 10.1038/srep12493
                PMC ID: 4513342
                PubMed ID: 26205001
                SO-VID: c9fb6f6d-ab9f-4340-9f62-0d7d923ca90f
                Copyright © Copyright © 2015, Macmillan Publishers Limited
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 05 January 2015
                Date accepted : 30 June 2015
                Categories
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