Baseline absolute neutrophil count (ANC), derived neutrophil-to-lymphocyte ratio (dNLR) and platelet-to-lymphocyte ratio (PLR) and outcome in non small cell lung cancer (NSCLC) treated with nivolumab or docetaxel: a preliminary analysis

BackgroundAn elevated peripheral blood derived neutrophil-to-lymphocyte ratio (dNLR) is a negative prognostic marker for patients with non-small cell lung cancer (NSCLC) receiving chemotherapy and immune checkpoint inhibitors. Whether dNLR is also associated with clinical outcomes to first-line pembrolizumab among patients with NSCLC and a programmed cell death ligand 1 (PD-L1) Tumor Proportion Score (TPS) of ≥50% is uncertain. How dNLR relates to the tumor immune microenvironment is also unclear.MethodsIn two participating academic centers, we retrospectively analyzed the dNLR (defined as the absolute neutrophil count/white cell count – absolute neutrophil count) prior to initiation of first-line pembrolizumab in patients with metastatic NSCLC and a PD-L1 TPS ≥50% and lacking genomic alterations in EGFR and ALK. An unbiased recursive partitioning algorithm was used to investigate an optimal dNLR cut-off with respect to objective response rate (ORR). Multiplexed immunofluorescence for CD8+, FOXP3+, PD-1+, and PD-L1 was performed on a separate cohort of NSCLCs to determine the immunophenotype associated with dNLR.ResultsA total of 221 patients treated with first-line pembrolizumab were included in this study. The optimal dNLR cut-off to differentiate treatment responders from non-responders was 2.6. Compared with patients with a dNLR ≥2.6 (n=97), patients with dNLR <2.6 (n=124) had a significantly higher ORR (52.4% vs 24.7%, p<0.001), a significantly longer median progression-free survival (mPFS 10.4 vs 3.4 months, HR 0.48, 95% CI 0.35 to 0.66, p<0.001), and a significantly longer median overall survival (mOS 36.6 vs 9.8 months, HR 0.34, 95% CI 0.23 to 0.49, p<0.001). After adjusting for age, sex, tobacco use, performance status, histology, serum albumin level, oncogenic driver status, and PD-L1 distribution (50%–89% vs ≥90%), a dNLR <2.6 was confirmed to be an independent predictor of longer mPFS (HR 0.47, 95% CI 0.33 to 0.67, p<0.001) and mOS (HR 0.32, 95% CI 0.21 to 0.49, p<0.001). Among advanced NSCLC samples with a PD-L1 TPS of ≥50%, those with a dNLR <2.6 had significantly higher numbers of tumor-associated CD8+, FOXP3+, PD-1 +immune cells, and PD-1 +CD8+T cells than those with a dNLR ≥2.6.ConclusionsAmong patients with NSCLC and a PD-L1 TPS ≥50%, a low dNLR has a distinct immune tumor microenvironment and more favorable outcomes to first-line pembrolizumab.

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Prognostic value of Platelet-to-Lymphocyte Ratio (PLR) and IL-6 in patients with small cell lung cancer

Diagnostyka Laboratoryjna ◽

10.5604/01.3001.0013.7698 ◽

2018 ◽

Vol 54 (3) ◽

pp. 137-144

Author(s):

Ewa Wójcik ◽

Zofia Stasik ◽

Urszula Rychlik ◽

Jadwiga Tarapacz ◽

Jan Kanty Kulpa ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Tumour Marker ◽

Small Cell ◽

Disease Stage ◽

Small Cell Lung ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Favourable Prognosis

Background: In order to identify patients with the most favourable prognosis, the effect of baseline level of interleukin-6 (IL-6) and platelet-to-lymphocyte ratio (PLR) on survival was analysed in patients with small cell lung cancer.<br>Material and Methods: 159 patients with small cell lung cancer were enrolled. Full blood count enabling computing the PLR, as well as NSE, ProGRP and IL-6 levels were done in all participants.<br>Results: We demonstrated significant effect of disease stage, performance status, sex, initial NSE, ProGRP and IL-6 levels as well as PLR on survival of patients with SCLC. In subgroups with normal initial levels of ProGRP (below 50.36 ng/L) and NSE (below 20.95 μg/L), the IL-6 level above 6.0 ng/L worsens the prognosis by 28% and 29%, respectively. In a subgroup with elevated initial ProGRP, the difference in survival between patients with normal vs elevated IL-6 level at baseline was 25%, whereas in a subgroup with elevated initial NSE it was 14%. The between-subgroup differences in PLR were less considerable. There was a significant effect of PLR on patient survival in a subgroup with normal initial NSE level and elevated initial ProGRP level.<br>Conclusion: In subgroups of SCLC patients identified based on initial tumour marker levels, IL-6 level can be a source of reliable prognostic information, whereas the effect of PLR is less marked. Patients with normal tumour marker levels and IL-6 below 6 ng/L at baseline have the most favourable prognosis.

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Initial neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as prognostic markers in patients with inoperable locally advanced non-small-cell lung cancer

Biomarkers in Medicine ◽

10.2217/bmm-2019-0583 ◽

2020 ◽

Vol 14 (14) ◽

pp. 1341-1352

Author(s):

Siyu Sun ◽

Yanli Qu ◽

Fengyun Wen ◽

Hong Yu

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Prognostic Value ◽

Locally Advanced ◽

Small Cell ◽

Hazard Ratio ◽

Small Cell Lung ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio

Aim: To determine whether pretreatment of neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR) has a prognostic value in patients with inoperable locally advanced non-small-cell lung cancer. Materials & methods: A total of 167 patients between 2013 and 2016 were analyzed retrospectively. Results: Appropriate cut-off values for initial NLR (3.06) and PLR (168.03) were determined by receiver operating characteristic curves. High NLR (p < 0.001 and p < 0.001) was related to poor overall survival (OS) and progression-free survival (PFS) via univariate analysis. Multivariable analysis showed that NLR can independently influence OS (hazard ratio: 1.570; p = 0.012) and PFS (hazard ratio: 1.471; p = 0.023). PLR did not correlate with OS or PFS. Conclusion: Pretreatment of NLR could independently predict the prognosis of inoperable locally advanced non-small-cell lung cancer patients, while pretreatment of PLR does not have prognostic value.

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Prognostic value of platelet to lymphocyte ratio in patients with non-small cell lung cancer

Journal of Solid Tumors ◽

10.5430/jst.v9n1p8 ◽

2019 ◽

Vol 9 (1) ◽

pp. 8

Author(s):

Mohammad Sabry Elkady ◽

Ghada Refaat ◽

Zeinab Elsayed ◽

Kyrillus Farag

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Prognostic Value ◽

Prognostic Significance ◽

Small Cell ◽

Small Cell Lung ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Pre Treatment

Background: The prognostic value of Platelet-to-lymphocyte ratio (PLR) in patients with non-small-cell lung cancer (NSCLC) is still indistinct. We conducted this study to assess the prognostic significance of pretreatment PLR in patients with unresectable NSCLC.Aim of the Work: To assess the prognostic significance of pre-treatment PLR in patients with NSCLC.Material and Methods: We retrospectively reviewed 130 patients treated for NSCLC with definitive/palliative chemotherapy and/or radiotherapy in Ain-Shams Universit hospital, Clinical Oncology department between January 2014 and December 2016. Pre-treatment CBC was available for the 130 patients to calculate PLR by dividing the absolute platelet count by the absolute lymphocytic count.Results: Out of 130 patients with available pre-treatment complete blood picture, population age ranged from 23 to 87 years. Male to female ratio was 4.8:1. Adenocarcinoma presents 51% of cases. Unresectable stage II and stage III present 2% and 27% respectively, while Stage IV presents 69%. Using a cut-off value of 150, a statistically significant correlation between baseline PLR > 150 and presence of distant metastases was found (p = .043); with a trend towards less advanced stage disease among group of patients with baseline PLR < 150 (p = .064). High PLR > 150 was significantly associated with poor overall survival (OS) (median OS: 10.33 months; 95% CI: 6.23-14.42, compared to patients with PLR < 150; (median OS: 24.63 months, 95% CI:11.5-37.76, p = .008), but not PFS. In multivariate analysis, PLR < 150 was an independent good prognostic factor for OS; (HR = 0.549; 95% CI: 0.314-0.958; p = .035).Conclusion: High PLR is associated with poor OS in patients with unresectable NSCLC.

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