Neutrophil-To-Lymphocyte Ratio Predicted Long-Term Chemotherapy Benefits In Stage IIIB-IV Non-Squamous Non-Small Cell Lung Cancer Patients Without Sensitive Mutations

Abstract

Xing Li,1,* Wei-Hua Zeng,2,* Yu-Qi Zhou,3,* Yan-Ying Ji,4 Wei-Zhan Li,2 Li-Yi Zhang,3 Yue-Fei Guo,5 Ding-Yun Feng,3 Tian-Tuo Zhang3 1Department of Oncology and Guangdong Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China; 2Department of Oncology, Panyu Central Hospital, Guangzhou 511400, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China; 4Department of Pathology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China; 5Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China*These authors contributed equally to this workCorrespondence: Tian-Tuo Zhang; Ding-Yun FengDepartment of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, People’s Republic of ChinaTel [phone]Email [email protected]; [email protected]: To investigate the predictive capability of clinical parameters for long-term chemotherapy benefits among stage IIIB-IV non-squamous non-small cell lung cancer (NSCLC) patients without sensitive mutations.Patients and methods: We investigated the clinical features of 206 stage IIIB-IV non-squamous NSCLC patients without sensitive mutations and assessed their predictive value for disease control rate (DCR) at 6 and 12 months post-treatment.Results: Seventy-two patients received docetaxel and platinum-based chemotherapy while 134 received pemetrexed and platinum-based chemotherapy. The 6-month and 12-month DCR were 33 (45.8%) and 6 (8.3%) in the docetaxel group and 69 (51.5%) and 19 (14.2%) in the pemetrexed group, respectively. Univariate Cox regression revealed that age, sex, smoking history, adrenal gland metastasis, stage IV disease, neutrophil-to-lymphocyte ratio (NLR), and serum albumin were associated with unfavorable progression-free survival (PFS). Age, stage IV disease, and NLR were identified as independent predictors of PFS using multivariate analysis. NLR was the only parameter that could predict 3-month and 6-month DCRs. NLR and age were able to predict 12-month DCR, with NLR presenting a larger area under the curve. Kaplan–Meier curves demonstrated that patients with NLR > 2.231 displayed significantly reduced long-term disease control. The group with higher NLR had more male patients, lower ALB levels, and serum sodium levels as well as higher platelet counts.Conclusion: NLR was an independent predictor of long-term chemotherapy benefits among non-squamous NSCLC patients without sensitive mutations. Patients with lower NLR were optimal candidates for chemotherapy. Patients with high NLR may receive alternative treatments or be included in clinical trials.Keywords: non-small cell lung cancer, chemotherapy, disease control rate, neutrophil-to-lymphocyte ratio

Keywords

• non-small cell lung cancer
• chemotherapy
• disease control rate
• neutrophil-to-lymphocyte ratio