Neutrophil-lymphocyte ratio predicts recurrence in patients with resected stage 1 non-small cell lung cancer

Shinjiro Mizuguchi, Nobuhiro Izumi, Takuma Tsukioka, Hiroaki Komatsu, Noritoshi Nishiyama, Shinjiro Mizuguchi, Nobuhiro Izumi, Takuma Tsukioka, Hiroaki Komatsu, Noritoshi Nishiyama

Abstract

Background: The aim was to determine the prognostic value of the neutrophil-lymphocyte ratio (NLR) in patients with completely resected stage 1 non-small cell lung cancer (NSCLC).

Methods: The study enrolled 382 NSCLC patients, and an optimal NLR cutoff value was determined by ROC analysis. Patients were divided by preoperative NLR into low (< 1.5, n = 99), intermediate (1.5 ≤ NLR < 3.5, n = 245), and high (NLR ≥ 3.5, n = 38) value groups. Serum diacron-reactive oxygen metabolites (d-ROMs) were assayed in 33 consecutive patients and used as an indicator of oxidative stress.

Results: The mean NLR in patients with high d-ROMs (> 300 U.CARR, n = 16) was 1.72 ± 0.67, which was significantly higher than that in patients with low d-ROMs (1.41 ± 0.39, n = 17; P = 0.018). The 3-, 5- and 10-year survival rates in the three NLR groups were 92, 77, and 59% (low); 82, 70, and 50% (intermediate); and 76, 58, and 32% (high) (P = 0.034). The 1-, 3- and 5-year recurrence-free survival rates in the three groups were 98, 90, and 86% (low), 91, 77, and 74% (intermediate); and 92, 77, and 68% (high) (P = 0.033). Multivariate analysis found that although NLR was not predictive of overall survival, high NLR was an independent risk factor of recurrence (hazard ratio: 2.03, 95% confidence interval: 1.17-3.79, P = 0.011) as were as age, pathological stage, tumor differentiation, and lymph-vascular invasion.

Conclusions: A low preoperative NLR predicted good prognosis, and was associated with low systemic inflammation status in patients with stage 1 NSCLC. It may be helpful when considering intervals of routine follow-up or choice of adjuvant therapy.

Keywords: Neutrophil-lymphocyte ratio; Non-small cell lung cancer; Prognosis; Recurrence-free survival; Surgery.

Conflict of interest statement

Ethics approval and consent to participate

The Osaka city University Institutional Review Board (reference number 3361) approved this study for investigation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Distribution of NLR in individual patients with low and high serum d-ROM. Data are presented as upper and lower quartile range (box), median value (horizontal line), and middle 90% distribution (whisker line)
Fig. 2
Fig. 2
(a) Overall survival and (b) Recurrence-free survival of patients with resected stage 1 NSCLC according to the NLR. The overall survival rate and the recurrence-free survival rate of patients with low NLRs was significantly higher than that in patients with intermediate and high NLRs

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