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Dynamic evaluation of neutrophil-to-lymphocyte ratio as prognostic factor in stage III non-small cell lung cancer treated with chemoradiotherapy

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Abstract

Purpose

Locally advanced non-small cell lung cancer (LA-NSCLC) is frequently treated with chemoradiotherapy (CRT). Despite the efforts, long-term outcomes are poor, and novel therapies have been introduced to improve results. Biomarkers are needed to detect early treatment failure and plan future follow-up and therapies. Our aim is to evaluate the role of dynamics of neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced NSCLC treated with CRT.

Methods

We retrospectively reviewed patients diagnosed with LA-NSCLC receiving definitive CRT at our center from 2010 to 2015. Baseline and post-treatment NLR were collected from our center database. NLR was dichotomized (threshold = 4) and patients were divided into two groups based on the variation from baseline to post-treatment NLR. The prognostic role and association with response were examined with logistic regression and multivariate Cox regression model, respectively.

Results

Ninety-two patients were included. Our analysis shows that NLR after treatment is associated with response to treatment [OR in the multivariate analysis 4.94 (1.01–24.48); p value = 0.048]. Furthermore, NLR and ECOG are independent prognostic factors for progression-free survival (PFS) and overall survival (OS). Specifically, PFS was 25.79 months for the good prognosis group and 12.09 for the poor prognosis group [HR 2.98 (CI 95% = 1.74–5.10), p < 0.001]; and OS was 42.94 months and 18.86 months, respectively [HR 2.81 (CI 95% = 1.62–4.90), p < 0.001].

Conclusion

Dynamics of NLR have a prognostic value in stage III NSCLC treated with definitive CRT. Pre- and post-CRT NLR should be evaluated in prospective clinical trials involving consolidation treatment with immunotherapy.

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Acknowledgements

The authors would like to express our gratitude to Joanna Gołąb for her contribution providing language help for the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Medical Oncology, Hospital Universitario Doctor Peset, Comunitat Valenciana, 46017, Valencia, Spain

    V. Palomar-Abril, T. Soria-Comes, M. M. Ureste & I. C. M. Maiques

  2. Department of Applied Statistics, Operations Research and Quality, Universitat Politècnica de València, Comunitat Valenciana, Valencia, Spain

    S. T. Campos

  3. Centre for Quality and Change Management, Universitat Politècnica de València, Comunitat Valenciana, Valencia, Spain

    V. G. Bosch

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  1. V. Palomar-Abril
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Contributions

VP-A: designed the research, acquired the data, and contributed to the data analysis and interpretation. He also prepared the first draft of the manuscript edited and reviewed it. TS-C: designed the research, and helped with the data analysis and the preparation of the first draft of the manuscript. Moreover, she reviewed it and edited the final version. STC: participated in the design of the statistical analysis and also performed it. Besides this, she reviewed the manuscript and edited the final version. VGB: participated in the design of the statistical analysis and also performed it. Besides this, he reviewed the manuscript. MMU: helped with the study design, the data acquisition, and interpretation, and also reviewed the manuscript. IC MM: also conducted the study design, helped with the data interpretation, and edited the final version of the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to V. Palomar-Abril.

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Conflict of interest

The authors have no conflicts of interest to disclose.

Code availability

IRB number 25/17.

Ethics approval

The study was conducted in accordance with the Declaration of Helsinki and it was approved by the Ethics Committee of Hospital Univeristario Doctor Peset (IRB number 24/17). The manuscript has not been published and is not under consideration for publication elsewhere.

Research involving human participants and/or animals

The study was conducted in accordance with the Declaration of Helsinki and after obtaining approval of the institutional research ethical committee.

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Informed consent was exempted due to the retrospective nature of the study and assured anonymity.

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Palomar-Abril, V., Soria-Comes, T., Campos, S.T. et al. Dynamic evaluation of neutrophil-to-lymphocyte ratio as prognostic factor in stage III non-small cell lung cancer treated with chemoradiotherapy. Clin Transl Oncol 22, 2333–2340 (2020). https://doi.org/10.1007/s12094-020-02396-6

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  • DOI: https://doi.org/10.1007/s12094-020-02396-6

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