Department of Thoracic Surgery.
Hunan Key Laboratory of Early Diagnosis and Precision Treatment of Lung Cancer.
Int J Surg. 2023 Nov 1;109(11):3519-3526. doi: 10.1097/JS9.0000000000000650.
Neoadjuvant chemoimmunotherapy is an important therapeutic modality for resectable nonsmall cell lung cancer (NSCLC). The roles of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio in predicting the efficacy and prognosis of patients with resectable NSCLC receiving neoadjuvant chemoimmunotherapy remain uncertain. This study aimed to explore the association of baseline and preoperative NLR, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio with the treatment response and survival of patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy.
Data of patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy between May 2019 and July 2022 at our institute, were retrospectively analyzed. Peripheral blood cell counts were obtained at baseline and before surgery. Data that may affect treatment efficacy were also collected and analyzed, including age, sex, BMI, cumulative smoking exposure, pathological type, clinical stage, PD-L1 tumor proportion score, immune checkpoint inhibitors, dosage of neoadjuvant therapy, duration from final therapy to surgery, and baseline and preoperative oncological markers. The present work has been reported in compliance with REporting recommendations for tumor MARKer prognostic studies (REMARK) criteria and guidelines (Supplemental Digital Content 1, http://links.lww.com/JS9/A860 ).
A total of 116 patients were included in the study. Univariate logistic regression analysis showed that a higher baseline NLR ( P =0.001) and preoperative NLR ( P =0.001) were associated with a lower incidence of pathological complete response (pCR) following neoadjuvant therapy. Multivariate analysis indicated that a lower incidence of pCR was achieved in the high baseline NLR group ( P =0.014). Higher baseline NLR ( P =0.021), preoperative NLR ( P =0.004) and higher preoperative CEA levels ( P =0.059) were associated with shorter disease-free survival (DFS). Multivariate Cox proportional hazard regression analyses showed that shorter DFS was achieved in the high preoperative NLR group ( P =0.033).
In patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy, a higher baseline NLR was associated with a lower incidence of pCR, and a higher preoperative NLR was associated with a shorter DFS. However, a future prospective study with a large sample size and long-term follow-up is needed to verify the predictive value of NLR in these patients.
新辅助化疗免疫治疗是非小细胞肺癌（NSCLC）可切除患者的重要治疗方式。中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值和淋巴细胞与单核细胞比值在预测可切除 NSCLC 患者接受新辅助化疗免疫治疗的疗效和预后中的作用尚不确定。本研究旨在探讨基线和术前 NLR、血小板与淋巴细胞比值和淋巴细胞与单核细胞比值与可切除 NSCLC 患者接受新辅助化疗免疫治疗的治疗反应和生存的关系。
回顾性分析 2019 年 5 月至 2022 年 7 月在我院接受新辅助化疗免疫治疗的可切除 NSCLC 患者的数据。在基线和术前获得外周血细胞计数。还收集并分析了可能影响治疗效果的数据，包括年龄、性别、BMI、累积吸烟暴露、病理类型、临床分期、PD-L1 肿瘤比例评分、免疫检查点抑制剂、新辅助治疗剂量、末次治疗至手术的时间以及基线和术前肿瘤标志物。本研究符合肿瘤标志物预后研究报告建议（REMARK）标准和指南（补充数字内容 1，http://links.lww.com/JS9/A860）。
共纳入 116 例患者。单因素 logistic 回归分析显示，较高的基线 NLR（P=0.001）和术前 NLR（P=0.001）与新辅助治疗后病理完全缓解（pCR）发生率较低相关。多因素分析表明，基线 NLR 较高的患者 pCR 发生率较低（P=0.014）。较高的基线 NLR（P=0.021）、术前 NLR（P=0.004）和较高的术前 CEA 水平（P=0.059）与无病生存期（DFS）较短相关。多因素 Cox 比例风险回归分析显示，术前 NLR 较高的患者 DFS 较短（P=0.033）。
在接受新辅助化疗免疫治疗的可切除 NSCLC 患者中，较高的基线 NLR 与 pCR 发生率较低相关，较高的术前 NLR 与 DFS 较短相关。然而，需要进行未来的前瞻性研究，以验证 NLR 在这些患者中的预测价值。
