Sun Haifeng, Hu Pingping, Du Jiajun, Wang Xinying
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, P.R. China.
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250000, P.R. China.
Oncol Lett. 2018 Mar;15(3):4017-4025. doi: 10.3892/ol.2018.7781. Epub 2018 Jan 12.
Chemotherapy is widely administered to patients with advanced lung cancer; however, data regarding chemotherapeutic sensitivity are limited. The present study aimed to investigate the predictive value of inflammatory indexes for chemotherapeutic efficacy in advanced lung cancer. Patients with stage III and IV unresectable lung cancer that were treated with first-line chemotherapy between January 2007 and December 2011 were retrospectively identified, and chemotherapeutic response was evaluated following 2 or 3 chemotherapy cycles. Prior to chemotherapy, hematologic data and clinicopathological parameters were collected using electronic medical records. The associations between the main inflammatory indexes [which included the pretreatment neutrophil count (PNC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR)] and the chemotherapeutic efficacy, as well as the prognostic value of the indexes, were analyzed. According to the receiver operating characteristic curve, PLR failed to reach diagnostic accuracy for overall chemotherapeutic response. PNC and NLR were each classified into two groups according to the cut-off values (4.635×10/l for PNC and 2.443 ×10/l for NLR). The overall response rate was significantly higher in the low PNC [odds ratio, 3.261; 95% confidence interval (CI), 2.102-5.060; P<0.001, vs. high PNC] and low NLR groups (odds ratio, 1.596; 95% CI, 1.037-2.454; P=0.033, vs. high NLR). Univariate analyses showed that the high PNC (HR, 1.487) and high NLR groups (HR, 1.288) were associated with poor progression-free survival (PFS); however, NLR was considered statistically insignificant in multivariate analysis. In summary, high PNC and NLR values are associated with chemoresistance and an unfavorable prognosis, with the present study demonstrating that PNC has increased sensitivity when compared with other inflammatory indexes in predicting chemotherapeutic efficacy. Therefore, PNC has the potential to be used as a reliable and suitable predictor to stratify a high risk of chemoresistance in patients with stage III and IV unresectable lung cancer.
化疗广泛应用于晚期肺癌患者；然而，关于化疗敏感性的数据有限。本研究旨在探讨炎症指标对晚期肺癌化疗疗效的预测价值。回顾性纳入2007年1月至2011年12月期间接受一线化疗的Ⅲ期和Ⅳ期不可切除肺癌患者，并在2或3个化疗周期后评估化疗反应。化疗前，使用电子病历收集血液学数据和临床病理参数。分析主要炎症指标[包括化疗前中性粒细胞计数（PNC）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）]与化疗疗效之间的关联以及这些指标的预后价值。根据受试者工作特征曲线，PLR在总体化疗反应方面未达到诊断准确性。PNC和NLR根据临界值（PNC为4.635×10⁹/L，NLR为2.443×10⁹/L）各自分为两组。低PNC组（优势比，3.261；95%置信区间[CI]，2.102 - 5.060；P<0.001，与高PNC组相比）和低NLR组（优势比，1.596；95%CI，1.037 - 2.454；P = 0.033，与高NLR组相比）的总体缓解率显著更高。单因素分析显示，高PNC组（风险比，1.487）和高NLR组（风险比，1.288）与无进展生存期（PFS）较差相关；然而，在多因素分析中，NLR被认为无统计学意义。总之，高PNC和NLR值与化疗耐药和不良预后相关，本研究表明，与其他炎症指标相比，PNC在预测化疗疗效时具有更高的敏感性。因此，PNC有可能作为一种可靠且合适的预测指标，用于对Ⅲ期和Ⅳ期不可切除肺癌患者中化疗耐药高风险进行分层。
