Departments of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Departments of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
Ann Surg Oncol. 2021 Sep;28(9):4880-4890. doi: 10.1245/s10434-021-09690-9. Epub 2021 Feb 25.
Current evidence suggests that the neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in several types of cancer. In this study, we aimed to evaluate the prognostic impact of clinicopathological factors, including postoperative NLR, in patients with locally advanced non-small-cell lung cancer (LA-NSCLC) who underwent surgery after chemoradiotherapy (CRT) with or without postoperative adjuvant chemotherapy.
The medical records of LA-NSCLC patients treated with trimodality therapy at our institution between June 1999 and May 2019 were reviewed. The association between several clinicopathological factors and overall survival (OS) was analyzed.
A total of 168 patients were included in this study. Regarding the prognosis, the 5-year OS rate was 68.1%, and the 2-year recurrence-free survival rate was 66.1% in the entire population. In multivariate analysis, we identified that high postoperative NLR, not pretreatment or preoperative NLR, was one of the independent factors for unfavorable OS (NLR high vs NLR low; hazard ratio = 2.45, 95% confidence interval: 1.53-3.94, p < 0.001). In addition, among patients with high postoperative NLR, patients who received postoperative adjuvant chemotherapy showed significantly better 5-year OS compared with those who did not (p = 0.016). On the other hand, postoperative adjuvant chemotherapy had no impact on the prognosis in patients with low NLR (p = 0.19).
Our results suggest that high postoperative NLR was not only an independent unfavorable prognostic factor in patients with LA-NSCLC who were treated with trimodality therapy, but also a promising indicator for postoperative treatment in this population.
目前的证据表明，中性粒细胞与淋巴细胞比值（NLR）是几种类型癌症的预后因素。本研究旨在评估包括术后 NLR 在内的临床病理因素对接受放化疗（CRT）后手术且术后是否接受辅助化疗的局部晚期非小细胞肺癌（LA-NSCLC）患者的预后影响。
回顾了我院 1999 年 6 月至 2019 年 5 月间接受三联疗法治疗的 LA-NSCLC 患者的病历。分析了几个临床病理因素与总生存（OS）的关系。
本研究共纳入 168 例患者。就预后而言，整个人群的 5 年 OS 率为 68.1%，2 年无复发生存率为 66.1%。多因素分析表明，高术后 NLR（而非治疗前或术前 NLR）是影响 OS 的独立不利因素之一（NLR 高 vs NLR 低；风险比=2.45，95%置信区间：1.53-3.94，p<0.001）。此外，在高术后 NLR 的患者中，接受术后辅助化疗的患者 5 年 OS 明显优于未接受化疗的患者（p=0.016）。另一方面，术后辅助化疗对 NLR 低的患者的预后无影响（p=0.19）。
我们的结果表明，高术后 NLR 不仅是接受三联疗法治疗的 LA-NSCLC 患者的独立不利预后因素，也是该人群术后治疗的有前途的指标。
