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Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Locally Advanced Non-small-cell Lung Cancer Treated with Trimodality Therapy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Current evidence suggests that the neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in several types of cancer. In this study, we aimed to evaluate the prognostic impact of clinicopathological factors, including postoperative NLR, in patients with locally advanced non-small-cell lung cancer (LA-NSCLC) who underwent surgery after chemoradiotherapy (CRT) with or without postoperative adjuvant chemotherapy.

Methods

The medical records of LA-NSCLC patients treated with trimodality therapy at our institution between June 1999 and May 2019 were reviewed. The association between several clinicopathological factors and overall survival (OS) was analyzed.

Results

A total of 168 patients were included in this study. Regarding the prognosis, the 5-year OS rate was 68.1%, and the 2-year recurrence-free survival rate was 66.1% in the entire population. In multivariate analysis, we identified that high postoperative NLR, not pretreatment or preoperative NLR, was one of the independent factors for unfavorable OS (NLR high vs NLR low; hazard ratio = 2.45, 95% confidence interval: 1.53–3.94, p < 0.001). In addition, among patients with high postoperative NLR, patients who received postoperative adjuvant chemotherapy showed significantly better 5-year OS compared with those who did not (p = 0.016). On the other hand, postoperative adjuvant chemotherapy had no impact on the prognosis in patients with low NLR (p = 0.19).

Conclusions

Our results suggest that high postoperative NLR was not only an independent unfavorable prognostic factor in patients with LA-NSCLC who were treated with trimodality therapy, but also a promising indicator for postoperative treatment in this population.

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Acknowledgement

This work was supported by a Management Expenses Grant for National University Corporations in Japan. We would like to thank Editage (http://www.editage.com) for English language editing.

Funding

This work was supported by a Management Expenses Grant for National University Corporations in Japan.

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Authors and Affiliations

  1. Departments of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Shimpei Tsudaka MD, Hiromasa Yamamoto MD, PhD, Hiroki Sato MD, PhD, Ken Suzawa MD, PhD, Kazuhiko Shien MD, PhD, Kentaroh Miyoshi MD, PhD, Shinji Otani MD, PhD, Mikio Okazaki MD, PhD, Seiichiro Sugimoto MD, PhD, Masaomi Yamane MD, PhD & Shinichi Toyooka MD, PhD

  2. Departments of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Kuniaki Katsui MD, PhD

  3. Departments of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Katsuyuki Kiura MD, PhD

  4. Departments of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Susumu Kanazawa MD, PhD

  5. Departments of Thoracic Surgery, Okayama University Hospital, Okayama, Japan

    Hiromasa Yamamoto MD, PhD, Ken Suzawa MD, PhD, Kazuhiko Shien MD, PhD, Kentaroh Miyoshi MD, PhD, Shinji Otani MD, PhD, Mikio Okazaki MD, PhD, Masaomi Yamane MD, PhD & Shinichi Toyooka MD, PhD

  6. Departments of Radiology, Okayama University Hospital, Okayama, Japan

    Kuniaki Katsui MD, PhD & Susumu Kanazawa MD, PhD

  7. Departments of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan

    Katsuyuki Kiura MD, PhD

  8. Organ Transplant Center, Okayama University Hospital, Okayama, Japan

    Seiichiro Sugimoto MD, PhD

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  1. Shimpei Tsudaka MD
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  2. Hiromasa Yamamoto MD, PhD
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Corresponding author

Correspondence to Hiromasa Yamamoto MD, PhD.

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Disclosures

Katsuyuki Kiura; Ono Pharmaceutical Co., Ltd.; Boehringer Ingelheim Co., Ltd.; Taiho Pharmaceutical Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Nippon Kayaku Co., Ltd.; Bristol-Myers Squibb K.K.; MSD K.K.; Pfizer Japan Inc.; TEIJIN Pharma Limited.; KYORIN Pharmaceutical Co., Ltd.; Merck Biopharma Co., Ltd.; Daiichi Sankyo Co., Ltd.; SHIONOGI & Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; AstraZeneca K.K.; Eli Lilly Japan K.K.; Novartis International AG.

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Supplementary Information

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Supplementary material 1 (XLSX 20 kb)

10434_2021_9690_MOESM2_ESM.tif

Supplementary Fig. 1. ROC curves to determine the cutoff value for pretreatment, preoperative and postoperative NLR (TIF 512 kb)

10434_2021_9690_MOESM3_ESM.tif

Supplementary Fig. 2. Overall survival (OS) stratified by the completion of postoperative adjuvant chemotherapy in the high postoperative NLR (≥ 4.06) group of patients who underwent postoperative adjuvant chemotherapy (TIF 410 kb)

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Tsudaka, S., Yamamoto, H., Sato, H. et al. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Locally Advanced Non-small-cell Lung Cancer Treated with Trimodality Therapy. Ann Surg Oncol 28, 4880–4890 (2021). https://doi.org/10.1245/s10434-021-09690-9

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  • DOI: https://doi.org/10.1245/s10434-021-09690-9

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