Abstract
BackgroundInflammation-scores based on general inflammation markers are suggested as prognostic markers of overall survival (OS) in lung cancer. However, whether these inflammation-scores improves the prognostication performed by well-established prognostic markers is unsettled. In a large register-based lung cancer patient cohort, nine different inflammation-scores were compared, and their ability to optimize the prognostication of OS was evaluated.MethodsLung cancer patients diagnosed from 2009–2018 in The Central Denmark Region were identified in the Danish Lung Cancer Registry. Pre-treatment inflammation markers were extracted from the clinical laboratory information system. Prognostication of OS was evaluated by Cox proportional hazard models. Comparison of the inflammation-scores and their added value to established prognostic markers were assessed by Akaike's information criteria and Harrel's C-index.ResultsIn total, 5,320 patients with non-small cell lung cancer (NSCLC) and 890 patients with small cell lung cancer (SCLC) were identified. In NSCLC, the Aarhus composite biomarker score (ACBS), including albumin, C-reactive protein, neutrophil count, lymphocyte count and haemoglobin, and the neutrophil-lymphocyte-ratio (NLR) were superior. Furthermore, they improved the prognostication of OS significantly (p <0.0001) (ACBS: HR: 2.24 (95%CI: 1.97–2.54); NLR: HR: 1.58 (95%CI: 1.47 – 1.69)). In SCLC, three scores were equally superior and improved the prognostication of OS p < 0.0001): neutrophil–lymphocyte-ratio (HR:1.62 (95%CI: 1.38–1.90)), modified Glasgow Prognostic Score (mGPS) (HR:1.70 (95%CI: 1.55–1.86) and the Combined NLR and GPS (CNG) (HR:2.10 (95%CI: 1.77–2.49).ConclusionsThe ACBS was the optimal score in NSCLC, whereas neutrophil–lymphocyte-ratio, mGPS and CNG were equally superior in SCLC. Additionally, these inflammation-scores all optimised the prognostication of OS and added value to well-established prognostic markers.
Highlights
Lung cancer remains the leading cause of cancer-related death [1, 2]
Based on a comprehensive literature search, we identified nine inflammation-scores composed of general inflammation markers which have been previously evaluated in lung cancer patients [19]
We made a direct comparison of the inflammation-scores and found that the Aarhus Composite Biomarker Score (ACBS) and neutrophil-to-lymphocyte ratio (NLR) were the most optimal scores to predict an inferior overall survival (OS) in patients with Non-small cell lung cancer (NSCLC) while three scores, NLR, Modified Glasgow Prognostic Score (mGPS) and Combined NLR and GPS (CNG), were of equal superiority in patients with Small cell lung cancer (SCLC)
Summary
Lung cancer remains the leading cause of cancer-related death [1, 2]. To improve lung cancer survival, we need prognostic markers to identify patients at high risk of inferior survival. The tumor, node and metastasis (TNM) staging system, which classifies patients into clinical and pathological stages [3] and the Eastern cooperative oncology group performance status (ECOG PS), which is based on daily life activities [4], are the most well-established prognostic markers in lung cancer. Inflammation-scores based on general inflammation markers are suggested as prognostic markers of overall survival (OS) in lung cancer. Whether these inflammation-scores improves the prognostication per‐ formed by well-established prognostic markers is unsettled. In a large register-based lung cancer patient cohort, nine different inflammation-scores were compared, and their ability to optimize the prognostication of OS was evaluated
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