Bar-Ad V, Palmer J, Li L, Lai Y, Lu B, Myers R E, Ye Z, Axelrod R, Johnson J M, Werner-Wasik M, Cowan S W, Evans N R, Hehn B T, Solomides C C, Wang C
Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 S. 11th St., Philadelphia, PA, 19107, USA.
Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
Clin Transl Oncol. 2017 Jun;19(6):711-717. doi: 10.1007/s12094-016-1593-y. Epub 2016 Dec 1.
Many studies recently focus on complicated and expensive genomic tests, but the prognostic values of biochemical markers which are easily obtained in clinics are largely overlooked and without further exploration. This study assesses the association of neutrophil-lymphocyte-ratio (NLR) with prognosis of lung cancer patients.
In 1032 patients with histologically confirmed lung cancer, the association of pretreatment NLR values with overall survival (OS) was evaluated using a Cox proportional hazards model and the temporal relationship of longitudinal NLR was assessed using a mixed effects model.
Compared to the patients with a low pretreatment NLR value, those with elevated NLR exhibited a statistically significant worse OS with a hazard ratio (HR) of 1.50 (P < 0.0001) after adjusting for age, gender, race, smoking status, drinking status, tumor stage, tumor grade, histology, and treatments. A significant trend of increasing HRs along with increasing NLR values was observed. The increased risk of death conferred by pretreatment NLR values reached a peak level around 2 years after diagnosis. Moreover, in longitudinal analysis, we observed a trend of dramatically increased NLR values in patients who died during follow-up, but stable NLR values in those who were still alive, with a significant interaction of death-alive status with follow-up time (P < 0.0001).
Elevated NLR is a potential biomarker to identify lung cancer patients with poor prognosis and should be validated in a future clinical trial.
近期许多研究聚焦于复杂且昂贵的基因组检测，但临床中易于获取的生化标志物的预后价值在很大程度上被忽视且未得到进一步探究。本研究评估中性粒细胞与淋巴细胞比值（NLR）与肺癌患者预后的相关性。
在1032例经组织学确诊的肺癌患者中，使用Cox比例风险模型评估治疗前NLR值与总生存期（OS）的相关性，并使用混合效应模型评估纵向NLR的时间关系。
与治疗前NLR值低的患者相比，NLR升高的患者在调整年龄、性别、种族、吸烟状况、饮酒状况、肿瘤分期、肿瘤分级、组织学和治疗后，OS在统计学上显著更差，风险比（HR）为1.50（P < 0.0001）。观察到随着NLR值增加HRs增加的显著趋势。治疗前NLR值带来的死亡风险增加在诊断后约2年达到峰值水平。此外，在纵向分析中，我们观察到随访期间死亡患者的NLR值有显著增加的趋势，而仍存活患者的NLR值稳定，死亡-存活状态与随访时间有显著交互作用（P < 0.0001）。
升高的NLR是识别预后不良肺癌患者的潜在生物标志物，应在未来临床试验中进行验证。
