Journal of Radiation Oncology

, Volume 8, Issue 1, pp 13–21 | Cite as

Use of the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) for prognostication of patients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT): a systematic review

  • Daegan Sit
  • Thomas Raissi
  • Meredith Giuliani
  • Percy Lee
  • Narek Shaverdian
  • Cindy Walker-Dilks
  • Anand SwaminathEmail author


Background and purpose

The neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios are markers of systemic inflammation with uncertain prognostic utility. Thus, we conducted a systematic review of NLR and PLR as prognostic factors for overall survival (OS), progression-free survival (PFS), and local control (LC) of patients with stage 1 non-small cell lung cancer (NSCLC) following stereotactic body radiotherapy (SBRT) with curative intent.

Methods and materials

The EMBASE, Cochrane Library, MEDLINE, and PubMed databases were searched from January 1996 until September 2017 for primary research studies and systematic literature reviews that reported pre-treatment NLR and PLR of patients with stage 1 NSCLC and OS, PFS, and/or LC of patients following SBRT.


An electronic database search identified 292 articles, of which five were eligible for inclusion. Cutoffs for a high NLR ranged from 2.18 to 3.155 while cutoffs for a high PLR ranged from 146 to 187.27. Four studies reported outcomes related to disease control and had mixed results as to the utility of the NLR and PLR as a prognostic factor. Four studies analyzed the association between high NLR cutoff with OS and all found a statistically significant association. Three studies examined a high PLR cutoff and all found a statistically significant association with worse OS.


NLR and PLR appear to be relevant prognostic factors for OS following lung SBRT in stage I NSCLC. They may serve as accessible and inexpensive tests to aid in clinical decision-making but prospective validation is necessary.


Carcinoma Non-small cell lung Radiosurgery Radiotherapy Conformal Review Systematic Neutrophil to lymphocyte ratio Platelet to lymphocyte ratio Inflammation Prognosis 



Neutrophil to lymphocyte ratio


Platelet to lymphocyte ratio


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

Dr. Meredith Giuliani declares funding from Elekta Inc. and AstraZeneca that is unrelated to this work. Dr. Swaminath declares an educational grant from Accuray and advisory board membership from AstraZeneca that is unrelated to this work. Daegan Sit, Thomas Raissi, Percy Lee, Narek Shaverdian, and Cindy Walker-Dilks declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation Oncology, British Columbia Cancer AgencyUniversity of British ColumbiaVancouverCanada
  2. 2.Western University School of MedicineLondonCanada
  3. 3.Department of Radiation OncologyUniversity of TorontoTorontoCanada
  4. 4.Department of Radiation Oncology, Princess Margaret HospitalUniversity of TorontoTorontoCanada
  5. 5.Department of Radiation OncologyUniversity of California, Los AngelesLos AngelesUSA
  6. 6.Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  7. 7.Department of Oncology, Juravinski HospitalMcMaster UniversityHamiltonCanada
  8. 8.Escarpment Cancer Research InstituteHamiltonCanada
  9. 9.Radiation Oncology Fellowship ProgramMcMaster UniversityHamiltonCanada
  10. 10.Juravinski Cancer CentreHamiltonCanada

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