Elevated pretreatment neutrophil/white blood cell ratio and monocyte/lymphocyte ratio predict poor survival in patients with curatively resected non-small cell lung cancer: Results from a large cohort

Abstract

Background: The prognostic values of preoperative neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR) in non-small cell lung cancer (NSCLC) have been previously described. This study assessed the prognostic values of other pretreatment complete blood cell parameters in Chinese patients with curatively resected NSCLC.

Methods: A total of 1466 consecutive NSCLC patients who received curative surgery from January 1, 2005 to December 31, 2009 with complete data from pretreatment blood tests were enrolled in this retrospective study. Correlations between each blood test parameter and overall survival were examined by Kaplan-Meier method or Cox proportional hazards regression, followed by a stratification analysis of significant variables.

Results: Optimal cut-off values of 0.55 for neutrophil/white blood cell ratio (NWR), 0.28 for lymphocyte/white blood cell ratio (LWR), 0.09 for monocyte/white blood cell ratio (MWR), 2.06 for NLR, 0.35 for MLR, 204.00 for PLR, and 38.25 for platelet/white blood cell ratio (PWR) were identified using X-tile software. Univariate analysis suggested that NWR ≥ 0.55, LWR < 0.28, MWR ≥ 0.09, NLR ≥ 2.06, MLR ≥ 0.35, and PLR ≥ 204.00 predicted a poor prognosis in NSCLC patients. However, only NWR and MLR were identified as independent significant prognostic factors in multivariable analysis, especially in tumor node metastasis stage I and I/II/III NSCLCs.

Conclusion: Pretreatment NWR, MWR, LWR, NLR, MLR, and PLR values are associated with poor overall survival for patients with curatively resected NSCLC. NWR and MLR are independent prognostic factors in curatively resected NSCLC.

Keywords: Blood test; non-small cell lung cancer; prognosis; survival.

Figure 1

Patient selection process. A total of 1466 patients with non‐small cell lung cancer who underwent curative resection were included in this study.

Figure 2

Overall survival of 1466 non‐small cell lung cancer (NSCLC) patients.

Figure 3

Cut‐off values of neutrophil/white blood cell ratio (NWR), monocyte/white blood cell ratio (MWR), lymphocyte/white blood cell ratio (LWR), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), and platelet/white blood cell ratio (PWR) in 1466 non‐small cell lung cancer patients. The optimal cut‐off values were 0.55 for NWR, 0.28 for LWR, 0.09 for MWR, 2.06 for NLR, 0.35 for MLR, 204.00 for PLR, and 38.25 for PWR.

Figure 4

Overall survival of 1466 non‐small cell lung cancer patients according to neutrophil/white blood cell ratio (NWR), and monocyte/lymphocyte ratio (MLR), respectively. (a) The high NWR group has significantly poorer overall survival (OS) than the low NWR group. (b) The high MLR group has significantly poorer OS than the low MLR group.

Figure 5

Overall survival (OS) of 1466 non‐small cell lung cancer patients according to neutrophil/white blood cell ratio (NWR) and monocyte/lymphocyte ratio (MLR), stratified by tumor node metastasis (TNM) stage. Significant differences in OS can be observed in (a) TNM stage I but not in (b) TNM II and (c) TNM III, according to NWR. OS rates were significantly different in (d) TNM stage I, (e) TNM II, and (f) TNM III according to MLR.