Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Sci Rep. 2020 Nov 11;10(1):19523. doi: 10.1038/s41598-020-76644-8.
Clinical and pathological predictors have proved to be insufficient in identifying high-risk patients who develop cancer recurrence after tumour resection. We aimed to compare the prognostic ability of various inflammation markers in patients undergoing surgical resection of lung cancer. We consecutively included 2,066 patients with stage I-III non-small-cell lung cancer undergoing surgical resection at the center between 2005 and 2015. We evaluated prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio along with their perioperative changes. We conducted stepwise backward variable elimination and internal validation to compare the selected markers' predictive performance for postoperative recurrence-free survival and overall survival. Preoperative neutrophil-to-lymphocyte ratio independently predicts recurrence-free survival (HR: 1.267, 95% CI 1.064-1.509, p = 0.0079, on base-2 logarithmic scale) and overall survival (HR: 1.357, 95% CI 1.070-1.721, p = 0.0117, on base-2 logarithmic scale). The cut-off value is 2.3 for predicting both recurrence (sensitivity: 46.1% and specificity: 66.7%) and mortality (sensitivity: 84.2% and specificity: 40.4%). Advanced cancer stage, poor tumour differentiation, and presence of perineural infiltration were significantly correlated with higher preoperative neutrophil-to-lymphocyte ratio. We concluded that preoperative neutrophil-to-lymphocyte ratio is superior to prognostic nutritional index and platelet-to-lymphocyte ratio in predicting postoperative recurrence and mortality of patients undergoing surgical resection of non-small-cell lung cancer.
临床和病理预测因子已被证明不足以识别在肿瘤切除后发生癌症复发的高危患者。我们旨在比较在接受肺癌手术切除的患者中各种炎症标志物的预后能力。我们连续纳入了 2005 年至 2015 年在中心接受 I-III 期非小细胞肺癌手术切除的 2066 例患者。我们评估了预后营养指数、中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值及其围手术期变化。我们进行了逐步向后变量消除和内部验证,以比较所选标志物对术后无复发生存和总生存的预测性能。术前中性粒细胞与淋巴细胞比值独立预测无复发生存(HR:1.267,95%CI 1.064-1.509,p=0.0079,基于 2 的对数刻度)和总生存(HR:1.357,95%CI 1.070-1.721,p=0.0117,基于 2 的对数刻度)。预测复发的截断值为 2.3(灵敏度:46.1%,特异性:66.7%)和死亡率(灵敏度:84.2%,特异性:40.4%)。晚期癌症分期、肿瘤分化差和神经周围浸润的存在与术前较高的中性粒细胞与淋巴细胞比值显著相关。我们得出结论,术前中性粒细胞与淋巴细胞比值在预测接受非小细胞肺癌手术切除的患者的术后复发和死亡率方面优于预后营养指数和血小板与淋巴细胞比值。