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Prognostic Impact of C-Reactive Protein-to-Lymphocyte Ratio in Non-small Cell Lung Cancer: A Propensity Score-Matching Analysis

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

Abstract

Background

Many inflammatory and nutritional markers have been used to predict prognosis in lung cancer. The C-reactive protein (CRP)-to-lymphocyte ratio (CLR) is a useful prognostic factor in various cancers. However, the prognostic value of preoperative CLR in patients with non-small cell lung cancer (NSCLC) remains to be established. We examined the significance of the CLR compared with known markers.

Methods

A total of 1380 surgically resected NSCLC patients treated at two centers were recruited and divided into derivation and validation cohorts. After CLRs were calculated, patients were classified into high and low CLR groups based on the cutoff value determined by receiver operating characteristics curve analysis. Subsequently, we determined the statistical associations of the CLR with clinicopathological factors and prognosis and further analyzed its prognostic impact by propensity-score matching.

Results

Of all the inflammatory markers examined, CLR yielded the highest area-under-the-curve value. The prognostic impact of CLR remained significant after propensity-score matching. Prognosis was significantly worse in the high-CLR group than in the low-CLR group (5-year, disease-free survival [DFS]: 58.1% vs. 81.9%, P < 0.001; 5-year overall survival [OS]: 72.1% vs. 91.2%, P < 0.001). The results were confirmed in the validation cohorts. Multivariable analysis also showed high CLR as an independent factor for both DFS and OS (DFS: hazard ratio [HR] 1.42, P = 0.027; OS: HR 1.95, P = 0.0037).

Conclusions

Preoperative CLR is a useful marker for predicting the prognosis of NSCLC patients who have undergone surgery.

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Acknowledgment

The authors thank Sarah Ivins, PhD, and H. Nikki March, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Taichi Nagano MD, Fumihiko Kinoshita MD, PhD, Asato Hashinokuchi MD, Kyoto Matsudo MD, Kenji Watanabe MD, Shinkichi Takamori MD, PhD, Mikihiro Kohno MD, PhD, Naoko Miura MD, PhD, Tomoyoshi Takenaka MD, PhD & Tomoharu Yoshizumi MD, PhD

  2. Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Fumihiko Kinoshita MD, PhD

  3. Department of Biostatistics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan

    Mototsugu Shimokawa PhD

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  1. Taichi Nagano MD
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  2. Fumihiko Kinoshita MD, PhD
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Correspondence to Fumihiko Kinoshita MD, PhD.

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Supplementary Information

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Supplementary file1 (DOCX 109 KB)

10434_2023_13250_MOESM2_ESM.tiff

Supplemental Figure 1. Patient flowchart. KUH, Kyushu University Hospital; KCC, National Hospital Organization Kyushu Cancer Center; NSCLC, non-small cell lung cancer; pStage, pathological stage (TIFF 858 KB)

10434_2023_13250_MOESM3_ESM.tiff

Supplemental Figure 2. Kaplan–Meier curves showing survival of the internal cohort. (A) Disease-free survival and (B) overall survival of high and low CLR groups (TIFF 858 KB)

10434_2023_13250_MOESM4_ESM.tiff

Supplemental Figure 3. Kaplan–Meier curves showing survival of the external cohort. (A) Disease-free survival and (B) overall survival of high and low CLR groups (TIFF 858 KB)

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Nagano, T., Kinoshita, F., Hashinokuchi, A. et al. Prognostic Impact of C-Reactive Protein-to-Lymphocyte Ratio in Non-small Cell Lung Cancer: A Propensity Score-Matching Analysis. Ann Surg Oncol 30, 3781–3788 (2023). https://doi.org/10.1245/s10434-023-13250-8

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  • DOI: https://doi.org/10.1245/s10434-023-13250-8

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