Ishihara Masashi, Ochiai Ryosuke, Haruyama Terunobu, Sakamoto Takahiko, Tanzawa Shigeru, Honda Takeshi, Ota Shuji, Ichikawa Yasuko, Ishida Tsuyoshi, Watanabe Kiyotaka, Seki Nobuhiko
Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Kaga, Itabashi-ku, Tokyo, Japan.
Department of Pathology, Teikyo University School of Medicine, Kaga, Itabashi-ku, Tokyo, Japan.
Transl Lung Cancer Res. 2021 Jan;10(1):221-232. doi: 10.21037/tlcr-20-777.
Neutrophil-to-lymphocyte ratio (NLR) has recently attracted attention as a prognostic predictor in patients with non-small cell lung cancer (NSCLC) who receive immune checkpoint inhibitors (ICIs). However, the utility of NLR in relation to cytotoxic anticancer drugs or molecular targeted drugs remains unclear. We determined if NLR could predict the treatment efficacy and prognosis in NSCLC patients who receive cytotoxic anticancer drugs or molecular targeted drugs, as well as ICIs, in a cross-sectional manner.
Of 658 patients with advanced NSCLC who received first-line systemic treatment in our hospital between 2008 and 2019, 312 who met the analytical criteria were included in the study. We retrospectively analyzed the ability of NLR with a cut-off value of 5 to predict time to treatment failure (TTF) and overall survival (OS) in patients who received the following treatments: first-line treatment with molecular targeted drugs (mt group, n=100); first-line treatment with cytotoxic anticancer drugs (wt group, n=212); and first-line treatment with cytotoxic anticancer drugs followed by ICIs (ICI group, n=58).
In the high- and low-NLR mt subgroups, median TTFs were 6.7 and 14.9 months (P<0.01), respectively, and median survival times (MSTs) were 17.8 and 39.1 months (P<0.01), respectively. In the high- and low-NLR wt subgroups, median TTFs were 1.5 and 5.8 months (P<0.01), and MSTs were 6.3 and 20.7 months (P<0.01), respectively. In the high- and low-NLR ICI subgroups, median TTFs were 1.3 and 6.8 months (P<0.01), and MSTs were 9.2 and 25.8 months (P<0.01), respectively. Multivariate analysis identified NLR as a significant independent predictor of TTF [hazard ratio (HR) 1.89, P=0.01; HR 2.51, P<0.01; and HR 5.06, P<0.01 in the mt, wt, and ICI groups, respectively) and OS (HR 3.81, P<0.01; HR 2.59, P<0.01; and HR 2.48, P<0.01, respectively).
This study showed that NLR might be a predictor of treatment efficacy and prognosis in advanced NSCLC patients who receive various systemic treatments. This finding of consistent applicability of NLR to a wide variety of systemic treatments is of great significance.
中性粒细胞与淋巴细胞比值（NLR）最近作为接受免疫检查点抑制剂（ICI）的非小细胞肺癌（NSCLC）患者的预后预测指标受到关注。然而，NLR在细胞毒性抗癌药物或分子靶向药物方面的效用仍不明确。我们以横断面方式确定NLR是否能预测接受细胞毒性抗癌药物、分子靶向药物以及ICI的NSCLC患者的治疗疗效和预后。
在2008年至2019年期间于我院接受一线全身治疗的658例晚期NSCLC患者中，312例符合分析标准的患者纳入本研究。我们回顾性分析了以5为临界值的NLR预测接受以下治疗的患者治疗失败时间（TTF）和总生存期（OS）的能力：分子靶向药物一线治疗（mt组，n = 100）；细胞毒性抗癌药物一线治疗（wt组，n = 212）；细胞毒性抗癌药物一线治疗后使用ICI（ICI组，n = 58）。
在高NLR和低NLR的mt亚组中，中位TTF分别为6.7个月和14.9个月（P < 0.01），中位生存时间（MST）分别为17.8个月和39.1个月（P < 0.01）。在高NLR和低NLR的wt亚组中，中位TTF分别为1.5个月和5.8个月（P < 0.01），MST分别为6.3个月和20.7个月（P < 0.01）。在高NLR和低NLR的ICI亚组中，中位TTF分别为1.3个月和6.8个月（P < 0.01），MST分别为9.2个月和25.8个月（P < 0.01）。多因素分析确定NLR是TTF的显著独立预测因素[风险比（HR）分别为1.89，P = 0.01；HR 2.51，P < 0.01；以及HR 5.06，P < 0.01，分别在mt组、wt组和ICI组中]和OS（HR分别为3.81，P < 0.01；HR 2.59，P < 0.01；以及HR 2.48，P < 0.01）。
本研究表明，NLR可能是接受各种全身治疗的晚期NSCLC患者治疗疗效和预后的预测指标。NLR在多种全身治疗中具有一致适用性的这一发现具有重要意义。
