Aims

The neutrophil–lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival.

Materials and methods

A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment.

Results

In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06–2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49–3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5–3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76–4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001).

Conclusion

NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.

中文翻译：

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中性粒细胞-淋巴细胞比率和绝对淋巴细胞计数作为非小细胞肺癌根治性放疗患者的预后标志物

宗旨

中性粒细胞-淋巴细胞比值 (NLR) 和绝对淋巴细胞计数 (ALC) 已被提议作为非小细胞肺癌 (NSCLC) 的预后标志物。本研究的目的是检查非小细胞肺癌根治性放疗前后 NLR/ALC 与疾病复发和总生存率的关联。

材料和方法

一项对 2014 年 10 月 1 日至 2016 年 10 月 1 日在英国九个地点接受治愈性放疗的连续患者的回顾性研究。 进行多变量分析以评估治疗前 NLR/ALC 的能力，治疗后NLR/ALC 和 NLR/ALC 的变化，使用 Cox 比例风险模型调整混杂因素，以预测治疗 2 年内的疾病复发和总生存期。

结果

总共有 425 名患者被确定为具有完整的血液参数值。NLR/ALC 参数都不是疾病复发的独立预测因子。较高的前 NLR、后 NLR 和 NLR 的变化加上较低的后 ALC 都是较差生存的独立预测因素。接受者操作曲线分析发现前 NLR > 2.5（优势比 1.71，95% 置信区间 1.06-2.79，P < 0.05），后 NLR > 5.5（优势比 2.36，95% 置信区间 1.49-3.76，P < 0.001)，NLR 的变化 >3.6（优势比 2.41，95% 置信区间 1.5-3.91，P < 0.001）和 ALC < 0.8（优势比 2.86，95% 置信区间 1.76-4.69，P< 0.001) 在对混杂因素进行调整后，最佳地预测了单变量和多变量分析中较差的总体生存率。高危组与低危组的中位总生存期为：NLR 前 770 天与 1009 天（P = 0.34），NLR 后 596 天与 1287 天（P ≤ 0.001），NLR 变化 553 天与 1214 天（P ≤ 0.001）和 ALC 后 594 天对比 1287 天（P ≤ 0.001）。

结论

NLR 和 ALC 是全身性炎症的替代标志物，对接受治愈性放疗的 NSCLC 患者具有预后价值。这些简单且容易获得的参数可能在未来治疗后的风险分层中发挥作用，以告知监测协议的强度。