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Neutrophil-to-lymphocyte ratio can predict outcome in extensive-stage small cell lung cancer

Radiology and Oncology
Volume 54 (2020): Issue 4 (December 2020)
By:
Open Access
|Sep 2020

Figures & Tables

Figure 1

Probability of survival of all patients according to stage (p < 0.0001).
Probability of survival of all patients according to stage (p < 0.0001).

Figure 2

Probability of survival of extensive-stage disease small cell lung cancer patients according to neutrophil-to-lymphocyte ratio (NLR) cut-off 4 (p = 0.026) and NLR cut-off 5 (p = 0.036).
Probability of survival of extensive-stage disease small cell lung cancer patients according to neutrophil-to-lymphocyte ratio (NLR) cut-off 4 (p = 0.026) and NLR cut-off 5 (p = 0.036).

Patient characteristics regarding the disease stage

      VariableED-SCLC (n = 80)LD-SCLC (n = 60)p-values
      Age (years)            x̄ (SD)63.2 (9.1)63.0 (9.4)0.930
      Gender
           Male55 (68.8%)34 (56.7%)0.159
           Female25 (31.2%)26 (43.4%)
      Smoking
           Yes77 (96.2%)57 (95.0%)1.000
           No3 (3.8%)3 (5.0%)
      PS (ECOG)            0–164 (80.0%)52 (86.7%)0.368
           2–316 (20.0%)8 (13.3%)
      Chest irradiation
           Yes9 (11.2%)36 (60.0%)< 0.0001
           No71 (88.8%)24 (40.0%)
      PCI
           Yes2 (2.5%)10 (16.7%)0.004
           No78 (97.5%)50 (83.3%)
      Disease control
           Yes63 (78.8%)56 (93.3%)0.018
           No17 (21.2%)4 (6.7%)
      PFS (weeks)            x̄ (SD)30.1 (14.5)60.3 (57.9)< 0.0001
      OS (weeks)            x̄ (SD)48.3 (23.4)83.3 (59.3)< 0.0001
      Outcome
           dead79 (98.8%)46 (76.7%)0.013
           alive1 (1.2%)14 (23.3%)
      WBC count (x 109/l)            x̄ (SD)9.1 (3.7)9.2 (3.3)0.686
      Platelet count (x
      109/l)            x̄ (SD)293 (119)304 (95)0.249
      Hemoglobin (g/l)            x̄ (SD)130.9 (17.8)133.0 (16.8)0.540
      CRP (mg/l)            x̄ (SD)34.2 (44.6)21.2 (26.6)0.048
      Creatinine (umol/l)            x̄ (SD)81.9 (20.0)82.3 (29.6)0.443
      LDH (U/l)            x̄ (SD)336.2 (193.5)311.1 (607.3)0.004
      Lymphocytes (x
      109/l)            x̄ (SD)1.6 (0.8)1.7 (0.7)0.202
      Neutrophils (x 109/l)            x̄ (SD)6.6 (3.4)6.6 (3.2)0.812
      Monocytes (x109/l)            x̄ (SD)0.7 (0.3)0.7 (0.3)0.700
      NLR            x̄ (SD)5.1 (3.6)4.6 (3.4)0.485
      PLR            x̄ (SD)217.9 (119.9)213.4 (123.3)0.714
      LMR            x̄ (SD)2.5 (1.4)3.0 (2.4)0.271

Results of Cox regression analysis

VariableHR95.0% CI for HRp-value
ED-SCLCLowerUpper
Skin metastasesYes vs No0.0340.0060.1920.000
LDH< 241 vs. ≥ 2411.6911.1302.5300.011
Monocytes≤ 0.84 vs. > 0.841.0570.6751.6550.809
NLR< 4 vs. ≥ 41.4970.7572.9610.246
NLR< 5 vs. ≥ 50.7950.3911.6150.525
LD-SCLC
ECOG0–1 vs. 2–32.8651.0327.9530.043
Chest irradiationYes vs. No1.5580.7933.0470.195
PCIYes vs. No2.0380.8934.6540.091
HemoglobinNormal vs. Anemia1.4390.7732.6780.251
CreatinineNormal vs. Elevated1.4320.15513.1980.751

Prognostic parameters for survival – extensive-stage disease (ED)

VariableNo. of patientsMedian survival (weeks) - 95% CIp-values (log-rank test)
Skin metastasesYes No4 7615.9 (0.7–31.0) 46.9 (42.7–51.0)< 0.0001
LDH (U/l)< 241 ≥ 24126 3654.0 (45.4–62.6) 33.7 (22.8–44.6)0.017
NLR< 4 ≥ 440 4050.1 (43.5–56.8) 44.7 (37.4–52.0)0.026
NLR< 5 ≥ 550 3050.1 (44.7–55.6) 39.6 (30.7–48.5)0.036

Prognostic parameters for survival – all patients

VariableNo. of patientsMedian survival (weeks) - 95% CIp-values (log-rank test)
Extent of diseaseLD ED60 8064.1 (56.7–71.6) 45.7 (42.3–49.2)< 0.0001
Chest irradiationYes No45 9569.1 (63.3–75.0) 45.3 (39.0–51.6)< 0.0001
PCIYes No12 12869.0 (12.3–125.7) 49.1 (43.4–54.9)0.003
Disease controlYes No119 2153.4 (49.5–57.3) 36.4 (25.3–47.5)0.013
Hemoglobin (g/l)M ≥ 138 F ≥ 119 < 138 < 11978 6257.1 (50.6–63.6) 40.6 (28.9–52.3)0.006
CRP (mg/l)< 5.0 ≥ 5.035 10457.1 (48.9–65.4) 47.9 (41.4–54.3)0.026
LDH (U/l)< 241 ≥ 24155 5663.0 (53.0–73.0) 37.0 (27.7–46.3)0.002
Monocytes (x109/l)≤ 0.84 > 0.8499 4155.0 (49.5–60.5) 44.3 (33.2–55.4)0.048

Prognostic parameters for survival – limited-stage disease (LD)

VariableNo. of patientsMedian survival (weeks) - 95% CIp-values (log-rank test)
PS (ECOG)0–1 2–352 866.3 (57.6–75.0) 35.9 (8.3–63.4)0.007
Chest irradiationYes No36 2470.7 (51.8–89.6) 36.7 (16.1–57.3)0.003
PCIYes No10 50102.0 (0.0–209.6) 58.3 (46.7–69.8)0.032
Hemoglobin (g/l)M ≥ 138 F ≥ 119 < 138 < 11935 2571.9 (57.0–86.8) 54.3 (17.7–90.9)0.033
Creatinine (umol/l)M < 125 F < 107 ≥ 125 ≥ 10757 366.3 (58.6–74.0) 32.9 (27.8–37.9)0.001
DOI: https://doi.org/10.2478/raon-2020-0054 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 437 - 446
Submitted on: Feb 18, 2020
Accepted on: Jul 22, 2020
Published on: Sep 22, 2020
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
small cell lung cancer,
hematological markers,
neutrophil-to-lymphocyte ratio,
platelet-to-lymphocyte ratio,
lymphocyte-to-monocyte ratio
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2020 Gordana Drpa, Maja Sutic, Jurica Baranasic, Marko Jakopovic, Miroslav Samarzija, Suzana Kukulj, Jelena Knezevic, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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