Prognostic impact of neutrophil-to-lymphocyte ratio (NLR) pre and post chemoradiotherapy (CRT) in stage III non-small cell lung cancer (NSCLC)

Abstract

There is scarce data of the impact of inflammatory indexes in locally advanced NSCLC, which is a highly heterogeneous illness. Choice of therapy is complex and often, combined CRT, either concurrently or sequentially is used. We aim to determine the impact of NLR monitoring in patients with stage III NSCLC treated with CRT.Patients with stage III NSCLC treated with CRT were identified from Jan2010 to Dec2015 in our centre. NLR (neutrophils/lymphocytes) was retrospectively collected at baseline (B) and 5-6 weeks after CRT (C). It was considered a continuous variable and categorised (low <4, high ≥4). NLR monitoring (B and C) stratified 2 groups: good (NLR remained <4 and NLR decreased ≥4 to < 4) and poor (NLR increased <4 to ≥ 4 and NLR remained ≥4). Progression-free survival (PFS) and overall survival (OS) were estimated with Kaplan-Meier method and log-rank test. Cox regression model was used for the multivariate analysis.92 patients were included; median age 65.5 years (39-83); 85.87% were male and 90.3% had ECOG 0-1. Predominant histologies: adenocarcinoma (41.3%) and squamous-cell carcinoma (56.5%). Concurrent treatment in 78.9% patients and sequential in 21.1%. Median PFS and OS were 16.23 and 30.36 months (mo), in the overall population. On the multivariate analysis, the good prognostic group had significant longer median PFS and OS than the poor group: 33.9 vs 11.1 mo (p <0.001Prognostic groups (good vs poor)3.00 (1.49 – 6.02)0.0022.83 (1.30 – 6.14)0.009NLR could be used as a prognostic factor in stage III NSCLC especially when considering its dynamic evolution. Our results provide the opportunity to evaluate this inexpensive and reproducible index as a prognostic or predictive biomarker in prospective studies, particularly with the novel use of anti-PD-1/L1 after CRT.Hospital Universitario Doctor Peset.Has not received any funding.All authors have declared no conflicts of interest.