Neutrophil-lymphocyte ratio predicts recurrence in patients with resected stage 1 non-small cell lung cancer
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RESEARCH ARTICLE
Open Access
Neutrophil-lymphocyte ratio predicts recurrence in patients with resected stage 1 non-small cell lung cancer Shinjiro Mizuguchi*, Nobuhiro Izumi, Takuma Tsukioka, Hiroaki Komatsu and Noritoshi Nishiyama
Abstract Background: The aim was to determine the prognostic value of the neutrophil-lymphocyte ratio (NLR) in patients with completely resected stage 1 non-small cell lung cancer (NSCLC). Methods: The study enrolled 382 NSCLC patients, and an optimal NLR cutoff value was determined by ROC analysis. Patients were divided by preoperative NLR into low (< 1.5, n = 99), intermediate (1.5 ≤ NLR < 3.5, n = 245), and high (NLR ≥ 3.5, n = 38) value groups. Serum diacron-reactive oxygen metabolites (d-ROMs) were assayed in 33 consecutive patients and used as an indicator of oxidative stress. Results: The mean NLR in patients with high d-ROMs (> 300 U.CARR, n = 16) was 1.72 ± 0.67, which was significantly higher than that in patients with low d-ROMs (1.41 ± 0.39, n = 17; P = 0.018). The 3-, 5- and 10-year survival rates in the three NLR groups were 92, 77, and 59% (low); 82, 70, and 50% (intermediate); and 76, 58, and 32% (high) (P = 0.034). The 1-, 3- and 5-year recurrence-free survival rates in the three groups were 98, 90, and 86% (low), 91, 77, and 74% (intermediate); and 92, 77, and 68% (high) (P = 0.033). Multivariate analysis found that although NLR was not predictive of overall survival, high NLR was an independent risk factor of recurrence (hazard ratio: 2.03, 95% confidence interval: 1. 17–3.79, P = 0.011) as were as age, pathological stage, tumor differentiation, and lymph-vascular invasion. Conclusions: A low preoperative NLR predicted good prognosis, and was associated with low systemic inflammation status in patients with stage 1 NSCLC. It may be helpful when considering intervals of routine follow-up or choice of adjuvant therapy. Keywords: Non-small cell lung cancer, Prognosis, Recurrence-free survival, Neutrophil-lymphocyte ratio, Surgery
Background Interest in links between systemic inflammation and the management of cancer is increasing. Many cancers develop at sites of infection, chronic irritation, and inflammation, and regardless of the location, inflammatory cells in the tumor microenvironment are indispensable participants in the neoplastic process, promoting cell proliferation, survival, angiogenesis, and migration [1]. Loss of tissue integrity caused by reduction of cellular adhesion is an early step in metastasis, allowing the spread of tumor cells from the primary tumor [2]. In mammary epithelial cells, malignant transformation and metastasis are stimulated by generation of endogenous reactive oxygen species (ROS) [3]. ROS * Correspondence: [email protected] Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
contribute to carcinogenesis and the aberrant growth, metastasis, and angiogenesis that are characteristic of malignant tumors [4, 5] and associated with oxidative stress. The evidenc
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