Neutrophil–Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer

A. Punjabi; E. Barrett; A. Cheng; A. Mulla; G. Walls; D. Johnston; J. McAleese; K. Moore; J. Hicks; K. Blyth; M. Denholm; L. Magee; D. Gilligan; S. Silverman; M. Qureshi; H. Clinch; M. Hatton; L. Philipps; S. Brown; M. O'Brien; F. McDonald; C. Faivre-Finn; C. Hiley; M. Evison

doi:10.1016/j.clon.2021.03.019

Neutrophil–Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer

A. Punjabi, E. Barrett, A. Cheng, A. Mulla, G. Walls, D. Johnston, J. McAleese, K. Moore, J. Hicks, K. Blyth, M. Denholm, L. Magee, D. Gilligan, S. Silverman, M. Qureshi, H. Clinch, M. Hatton, L. Philipps, S. Brown, M. O'BrienF. McDonald, C. Faivre-Finn, C. Hiley, M. Evison^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

15 Citations (Scopus)

Abstract

Aims: The neutrophil–lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival.

Materials and methods: A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment.

Results: In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06–2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49–3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5–3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76–4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001).

Conclusion: NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.

Original language	English
Pages (from-to)	e331-e338
Journal	Clinical Oncology
Volume	33
Issue number	8
Early online date	05 Jul 2021
DOIs	https://doi.org/10.1016/j.clon.2021.03.019
Publication status	Published - Aug 2021

Bibliographical note

Publisher Copyright:
© 2021 The Royal College of Radiologists

Keywords

Curative-intent radiotherapy
lung cancer
lymphocyte count
neutrophil–lymphocyte ratio
NSCLC

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.clon.2021.03.019Licence: Unspecified

Biophysical correlates of base-mediated radiation cardiotoxicity in non-small cell lung cancer
Walls, G. M. (Author), Butterworth, K. (Supervisor), Jain, S. (Supervisor) & Cole, A. (Supervisor), Jul 2023
Student thesis: Doctoral Thesis › Doctor of Philosophy

Cite this

Punjabi, A., Barrett, E., Cheng, A., Mulla, A., Walls, G., Johnston, D., McAleese, J., Moore, K., Hicks, J., Blyth, K., Denholm, M., Magee, L., Gilligan, D., Silverman, S., Qureshi, M., Clinch, H., Hatton, M., Philipps, L., Brown, S., ... Evison, M. (2021). Neutrophil–Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer. Clinical Oncology, 33(8), e331-e338. https://doi.org/10.1016/j.clon.2021.03.019

@article{ada72d0a6d2c44ffa8064d99c843345f,

title = "Neutrophil–Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer",

abstract = "Aims: The neutrophil–lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival. Materials and methods: A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment. Results: In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06–2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49–3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5–3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76–4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001). Conclusion: NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.",

keywords = "Curative-intent radiotherapy, lung cancer, lymphocyte count, neutrophil–lymphocyte ratio, NSCLC",

author = "A. Punjabi and E. Barrett and A. Cheng and A. Mulla and G. Walls and D. Johnston and J. McAleese and K. Moore and J. Hicks and K. Blyth and M. Denholm and L. Magee and D. Gilligan and S. Silverman and M. Qureshi and H. Clinch and M. Hatton and L. Philipps and S. Brown and M. O'Brien and F. McDonald and C. Faivre-Finn and C. Hiley and M. Evison",

note = "Publisher Copyright: {\textcopyright} 2021 The Royal College of Radiologists",

year = "2021",

month = aug,

doi = "10.1016/j.clon.2021.03.019",

language = "English",

volume = "33",

pages = "e331--e338",

journal = "Clinical Oncology",

issn = "0936-6555",

publisher = "Elsevier B.V.",

number = "8",

}

Punjabi, A, Barrett, E, Cheng, A, Mulla, A, Walls, G, Johnston, D, McAleese, J, Moore, K, Hicks, J, Blyth, K, Denholm, M, Magee, L, Gilligan, D, Silverman, S, Qureshi, M, Clinch, H, Hatton, M, Philipps, L, Brown, S, O'Brien, M, McDonald, F, Faivre-Finn, C, Hiley, C & Evison, M 2021, 'Neutrophil–Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer', Clinical Oncology, vol. 33, no. 8, pp. e331-e338. https://doi.org/10.1016/j.clon.2021.03.019

TY - JOUR

T1 - Neutrophil–Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer

AU - Punjabi, A.

AU - Barrett, E.

AU - Cheng, A.

AU - Mulla, A.

AU - Walls, G.

AU - Johnston, D.

AU - McAleese, J.

AU - Moore, K.

AU - Hicks, J.

AU - Blyth, K.

AU - Denholm, M.

AU - Magee, L.

AU - Gilligan, D.

AU - Silverman, S.

AU - Qureshi, M.

AU - Clinch, H.

AU - Hatton, M.

AU - Philipps, L.

AU - Brown, S.

AU - O'Brien, M.

AU - McDonald, F.

AU - Faivre-Finn, C.

AU - Hiley, C.

AU - Evison, M.

PY - 2021/8

Y1 - 2021/8

N2 - Aims: The neutrophil–lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival. Materials and methods: A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment. Results: In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06–2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49–3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5–3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76–4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001). Conclusion: NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.

AB - Aims: The neutrophil–lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival. Materials and methods: A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment. Results: In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06–2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49–3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5–3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76–4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001). Conclusion: NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.

KW - Curative-intent radiotherapy

KW - lung cancer

KW - lymphocyte count

KW - neutrophil–lymphocyte ratio

KW - NSCLC

U2 - 10.1016/j.clon.2021.03.019

DO - 10.1016/j.clon.2021.03.019

M3 - Article

C2 - 33863615

AN - SCOPUS:85104104803

SN - 0936-6555

VL - 33

SP - e331-e338

JO - Clinical Oncology

JF - Clinical Oncology

IS - 8

ER -

Neutrophil–Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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Student theses

Biophysical correlates of base-mediated radiation cardiotoxicity in non-small cell lung cancer

Cite this