Jun Wang

Department of Oncology, Jinan Military General Hospital

Objective: Neutrophilto lymphocyte ratio (NLR) has been shown to be a prognosis indicator indifferent types of cancer. We aimed to investigate the association between NLRand survival in surgery-treated non-small cell lung cancer (NSCLC) patients. Method:This large retrospective study included 1, 247 patients who underwentinitial surgery for stage I-III NSCLC at MD Anderson Cancer Center betweenDecember 2002 and November 2010. The relationship of NLR with clinicopathologicvariables, local recurrence-free survival (LRFS), distant recurrence-freesurvival (DRFS), overall survival (OS), and disease-specific survival (DSS) wasanalyzed. Kaplan-Meier methods were used to generate estimates of LRFS, DRFS, OS,and DSS in patients with high or low NLR. Hazard ratios (HRs) with 95%confidence intervals (CIs) were used to assess the prognostic strength of NLR. Result:High NLR was more likely to occur in patients with large tumor size (P=0.017),old age (P=0.002), squamous cell carcinoma (P=0.001), andadvanced clinical stage grade (P=0.018). At a median follow-up time of50.6 months, high NLR was associated with reduced DRFS (P=0.016), OS (P<0.001) and DSS (P=0.018), butnot was associated with LRFS. Multivariate Cox analysis further revealed thatNLR (HR=1.45; 95%CI=1.09-1.93; P=0.011), primary tumor size (HR=1.51;95%CI=1.13-2.02; P=0.005), lymphovascular invasion (HR=1.86; 95%CI=1.35-2.56;P<0.0001), nuclear grade (HR=1.17;95%CI=1.01-1.35; P=0.032), and pathologic lymph node invasion (HR=2.80;95%CI=2.08-3.76; P<0.0001) werestrong independent predictors for DRFS. NLR was also an independent markerpredicting poor OS (HR=1.34; 95%CI=1.09-1.63; P=0.004) and DSS (HR=1.32;95%CI=1.02-1.71; P=0.038). Conclusion: Pretreatment NLR may serveas a potential biomarker to predict distant recurrence and death in patientswith stage I-III NSCLC patients. Patients with high NLR would benefit a moreaggressive treatment strategy following surgery treatment.

KeyWords: Lung cancer  NLR  Prognosis