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. 2021 Apr 7:28:133-140.
doi: 10.1016/j.ctro.2021.03.010. eCollection 2021 May.

Prognostic utility of pretreatment neutrophil-lymphocyte ratio in survival outcomes in localized non-small cell lung cancer patients treated with stereotactic body radiotherapy: Selection of an ideal clinical cutoff point

Nikhil V Kotha  1   2 , Daniel R Cherry  1   2 , Alex K Bryant  3 , Vinit Nalawade  1   2 , Tyler F Stewart  2   4 , Brent S Rose  1   2
Affiliations

Prognostic utility of pretreatment neutrophil-lymphocyte ratio in survival outcomes in localized non-small cell lung cancer patients treated with stereotactic body radiotherapy: Selection of an ideal clinical cutoff point

Nikhil V Kotha et al. Clin Transl Radiat Oncol. .

Abstract

Background and purpose: Neutrophil-lymphocyte ratio (NLR) has been associated with overall survival (OS) in non-small cell lung cancer (NSCLC). We aimed to assess the utility of NLR as a predictor of lung cancer-specific survival (LCS) and identify an optimal, pretreatment cutoff point in patients with localized NSCLC treated with stereotactic body radiotherapy (SBRT) within the Veterans Affairs' (VA) national database.

Materials and methods: In the VA database, we identified patients with biopsy-proven, clinical stage I NSCLC treated with SBRT between 2006 and 2015. Cutoff points for NLR were calculated using Contal/O'Quigley's and Cox Wald methods. Primary outcomes of OS, LCS, and non-lung cancer survival (NCS) were evaluated in Cox and Fine-Gray models.

Results: In 389 patients, optimal NLR cutoff was identified as 4.0. In multivariable models, NLR > 4.0 was associated with decreased OS (HR 1.44, p = 0.01) and NCS (HR 1.68, p = 0.01) but not with LCS (HR 1.32, p = 0.09). In a subset analysis of 229 patients with pulmonary function tests, NLR > 4.0 remained associated with worse OS (HR 1.51, p = 0.02) and NCS (HR 2.18, p = 0.01) while the association with LCS decreased further (HR 1.22, p = 0.39).

Conclusion: NLR was associated with worse OS in patients with localized NSCLC treated with SBRT; however, NLR was only associated with NCS and not with LCS. Pretreatment NLR, with a cutoff of 4.0, offers potential as a marker of competing mortality risk which can aid in risk stratification in this typically frail and comorbid population. Further studies are needed to validate pretreatment NLR as a clinical tool in this setting.

Keywords: LCS, lung cancer-specific survival; NCS, non-lung cancer survival; NLR, Neutrophil-lymphocyte ratio; NSCLC, non-small cell lung cancer; Neutrophil-lymphocyte ratio; Non-small cell lung cancer; OS, overall survival; Prognostic factors; SBRT, stereotactic body radiotherapy; Stereotactic body radiotherapy; VA, Veterans Affairs; Veterans affairs (U.S.).

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Inclusion and exclusion criteria. (NSCLC = non-small cell lung cancer, SBRT = stereotactic body radiotherapy, PFTs = pulmonary function tests).
Fig. 2
Fig. 2
a. Kaplan-Meier curves for overall survival stratified by NLR cutoff value 4.0. b. Cumulative incidence curves for lung cancer-specific mortality stratified by NLR cutoff value 4.0. c. Cumulative incidence curves for non-lung cancer mortality stratified by NLR cutoff value 4.0.
Fig. 2
Fig. 2
a. Kaplan-Meier curves for overall survival stratified by NLR cutoff value 4.0. b. Cumulative incidence curves for lung cancer-specific mortality stratified by NLR cutoff value 4.0. c. Cumulative incidence curves for non-lung cancer mortality stratified by NLR cutoff value 4.0.
Fig. 2
Fig. 2
a. Kaplan-Meier curves for overall survival stratified by NLR cutoff value 4.0. b. Cumulative incidence curves for lung cancer-specific mortality stratified by NLR cutoff value 4.0. c. Cumulative incidence curves for non-lung cancer mortality stratified by NLR cutoff value 4.0.
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