Skip to main content

Preoperative lymphocyte count is a favorable prognostic factor of disease-free survival in non-small-cell lung cancer

Medical Oncology volume 30, Article number: 352 (2013) Cite this article

Abstract

Recently, the prognostic value of cancer-related inflammatory response has been revealed. Previous studies showed that peripheral neutrophils and lymphocytes had significant impact on the prognosis of advanced and early-node-negative non-small-cell lung cancer (NSCLC). The purpose of this study was to investigate the prognostic value of preoperative lymphocyte and neutrophil counts in patients with NSCLC who underwent lobectomy and lymph node dissection and adjuvant chemotherapy. Retrospective analyses were performed to examine the impact of preoperative peripheral lymphocyte and neutrophil counts on disease-free survival (DFS) and overall survival (OS) and to analyze the relationships of these factors to clinicopathological factors. A total of 142 patients with NSCLC were evaluated of which 57 (40.1 %) patients had local recurrence or metastasis. Multivariate analyses revealed that peripheral lymphocyte count was an independent favorable prognostic factor of DFS (hazard ratio 0.548; 95 % confidence interval 0.351–0.857; P = 0.008) but not OS (P = 0.164). The maximum logrank statistical value was 9.504 (P = 0.002) when the cutoff value of lymphocyte was 1,800 mm−3. The median DFS was 318.0 days (95 % confidence interval 226.0–410.0) for lymphocyte ≤1,800 mm−3 group and 669.0 days (95 % confidence interval 0.0–1,431.0) for lymphocyte >1,800 mm−3 group. Low lymphocyte count was related with lymphatic invasion (P = 0.012) and recurrence of NSCLC (P = 0.022). Peripheral neutrophil count had no impact on DFS or OS when analysis included all the 142 patients. Preoperative peripheral lymphocyte count, which is related with lymphatic invasion, is an independent favorable prognostic factor of DFS in patients with NSCLC who underwent lobectomy and lymph node dissection and adjuvant chemotherapy.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Jemal A, et al. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300.

    PubMed  Article  Google Scholar 

  2. Mountain CF. Revisions in the international system for staging lung cancer. Chest. 1997;111(6):1710–7.

    PubMed  Article  CAS  Google Scholar 

  3. O’Dowd C, et al. Elevated preoperative C-reactive protein predicts poor cancer specific survival in patients undergoing resection for non-small cell lung cancer. J Thorac Oncol. 2010;5(7):988–92.

    PubMed  Google Scholar 

  4. Tauler J, Mulshine JL. Lung cancer and inflammation: interaction of chemokines and hnRNPs. Curr Opin Pharmacol. 2009;9(4):384–8.

    PubMed  Article  CAS  Google Scholar 

  5. Kobayashi N, et al. Preoperative lymphocyte count is an independent prognostic factor in node-negative non-small cell lung cancer. Lung Cancer. 2012;75(2):223–7.

    PubMed  Article  Google Scholar 

  6. Fietta AM, et al. Systemic inflammatory response and downmodulation of peripheral CD25+ Foxp3+ T-regulatory cells in patients undergoing radiofrequency thermal ablation for lung cancer. Hum Immunol. 2009;70(7):477–86.

    PubMed  Article  CAS  Google Scholar 

  7. Wislez M, et al. Neutrophils promote aerogenous spread of lung adenocarcinoma with bronchioloalveolar carcinoma features. Clin Cancer Res. 2007;13(12):3518–27.

    PubMed  Article  CAS  Google Scholar 

  8. Hespanhol V, et al. Survival predictors in advanced non-small cell lung cancer. Lung Cancer. 1995;13(3):253–67.

    PubMed  Article  CAS  Google Scholar 

  9. Muers MF, Shevlin P, Brown J. Prognosis in lung cancer: physicians’ opinions compared with outcome and a predictive model. Thorax. 1996;51(9):894–902.

    PubMed  Article  CAS  Google Scholar 

  10. Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest. 2009;136(1):260–71.

    PubMed  Article  Google Scholar 

  11. Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2007;2(7):593–602.

    PubMed  Article  Google Scholar 

  12. Fogar P, et al. Decreased total lymphocyte counts in pancreatic cancer: an index of adverse outcome. Pancreas. 2006;32(1):22–8.

    PubMed  Article  Google Scholar 

  13. Clark EJ, et al. Preoperative lymphocyte count as a prognostic factor in resected pancreatic ductal adenocarcinoma. HPB (Oxford). 2007;9(6):456–60.

    Article  CAS  Google Scholar 

  14. Ownby HE, et al. Peripheral lymphocyte and eosinophil counts as indicators of prognosis in primary breast cancer. Cancer. 1983;52(1):126–30.

    PubMed  Article  CAS  Google Scholar 

  15. Espinosa E, et al. Serum albumin and other prognostic factors related to response and survival in patients with advanced non-small cell lung cancer. Lung Cancer. 1995;12(1–2):67–76.

    PubMed  Article  CAS  Google Scholar 

  16. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357(9255):539–45.

    PubMed  Article  CAS  Google Scholar 

  17. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860–7.

    PubMed  Article  CAS  Google Scholar 

  18. Gooden MJ, et al. The prognostic influence of tumour-infiltrating lymphocytes in cancer: a systematic review with meta-analysis. Br J Cancer. 2011;105(1):93–103.

    PubMed  Article  CAS  Google Scholar 

  19. Zhang L, et al. Intratumoral T cells, recurrence, and survival in epithelial ovarian cancer. N Engl J Med. 2003;348(3):203–13.

    PubMed  Article  CAS  Google Scholar 

  20. Mlecnik B, et al. Histopathologic-based prognostic factors of colorectal cancers are associated with the state of the local immune reaction. J Clin Oncol. 2011;29(6):610–8.

    PubMed  Article  Google Scholar 

  21. Kawai O, et al. Predominant infiltration of macrophages and CD8(+) T Cells in cancer nests is a significant predictor of survival in stage IV nonsmall cell lung cancer. Cancer. 2008;113(6):1387–95.

    PubMed  Article  CAS  Google Scholar 

  22. Hiraoka K, et al. Concurrent infiltration by CD8(+) T cells and CD4(+) T cells is a favourable prognostic factor in non-small-cell lung carcinoma. Br J Cancer. 2006;94(2):275–80.

    PubMed  Article  CAS  Google Scholar 

  23. Zikos TA, et al. Lung T-cell subset composition at the time of surgical resection is a prognostic indicator in non-small cell lung cancer. Cancer Immunol Immunother. 2011;60(6):819–27.

    PubMed  Article  CAS  Google Scholar 

  24. Donnem T, et al. Combination of low vascular endothelial growth factor A (VEGF-A)/VEGF receptor 2 expression and high lymphocyte infiltration is a strong and independent favorable prognostic factor in patients with nonsmall cell lung cancer. Cancer. 2010;116(18):4318–25.

    PubMed  Article  CAS  Google Scholar 

  25. Rosenberg SA. Progress in human tumour immunology and immunotherapy. Nature. 2001;411(6835):380–4.

    PubMed  Article  CAS  Google Scholar 

  26. Wakabayashi O, et al. CD4(+) T cells in cancer stroma, not CD8(+) T cells in cancer cell nests, are associated with favorable prognosis in human non-small cell lung cancers. Cancer Sci. 2003;94(11):1003–9.

    PubMed  Article  CAS  Google Scholar 

  27. Mori M, et al. Infiltration of CD8+ T cells in non-small cell lung cancer is associated with dedifferentiation of cancer cells, but not with prognosis. Tohoku J Exp Med. 2000;191(2):113–8.

    PubMed  Article  CAS  Google Scholar 

  28. Kim HJ, et al. Loss of the promyelocytic leukemia protein in gastric cancer: implications for IP-10 expression and tumor-infiltrating lymphocytes. PLoS ONE. 2011;6(10):e26264.

    PubMed  Article  CAS  Google Scholar 

  29. Kopfstein L, et al. Distinct roles of vascular endothelial growth factor-D in lymphangiogenesis and metastasis. Am J Pathol. 2007;170(4):1348–61.

    PubMed  Article  CAS  Google Scholar 

  30. Al-Shibli KI, et al. Prognostic effect of epithelial and stromal lymphocyte infiltration in non-small cell lung cancer. Clin Cancer Res. 2008;14(16):5220–7.

    PubMed  Article  CAS  Google Scholar 

  31. Park SY, et al. Tumor necrosis as a prognostic factor for stage IA non-small cell lung cancer. Ann Thorac Surg. 2011;91(6):1668–73.

    PubMed  Article  Google Scholar 

  32. Igai H, et al. Clinicopathological study of p-T1aN0M0 non-small-cell lung cancer, as defined in the seventh edition of the TNM classification of malignant tumors. Eur J Cardiothorac Surg. 2011;39(6):963–7.

    PubMed  Article  Google Scholar 

  33. Biaoxue R, et al. Decreased expression of decorin and p57(KIP2) correlates with poor survival and lymphatic metastasis in lung cancer patients. Int J Biol Markers. 2011;26(1):9–21.

    PubMed  Article  Google Scholar 

  34. Sarraf KM, et al. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg. 2009;137(2):425–8.

    PubMed  Article  Google Scholar 

  35. Teramukai S, et al. Pretreatment neutrophil count as an independent prognostic factor in advanced non-small-cell lung cancer: an analysis of Japan Multinational Trial Organisation LC00-03. Eur J Cancer. 2009;45(11):1950–8.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

We thank Doctor Liu Yong and Doctor Pan Yuhang at The Third Affiliated Hospital of Sun Yat-sen University for the help of pathological detection.

Conflict of interest

The authors have no conflicts of interest to declare.

Author information

Affiliations

  1. Thoracic Surgery Department and Clinical Research Center for Thoracic Oncology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, China

    Jian Zhang, Shao-Hong Huang, Hui Li, Yun Li, Xiu-Ling Chen, Wei-Qing Zhang, Hui-Guo Chen & Li-Jia Gu

Authors
  1. Jian Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shao-Hong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hui Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiu-Ling Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei-Qing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hui-Guo Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Li-Jia Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Li-Jia Gu.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Zhang, J., Huang, SH., Li, H. et al. Preoperative lymphocyte count is a favorable prognostic factor of disease-free survival in non-small-cell lung cancer. Med Oncol 30, 352 (2013). https://doi.org/10.1007/s12032-012-0352-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-012-0352-3

Keywords

  • Non-small-cell lung cancer
  • Prognostic factor
  • Lymphatic count
  • Neutrophil count
  • Lymphatic invasion
  • Adjuvant chemotherapy
  • Disease-free survival