Abstract
BackgroundFor selected early stage small cell lung cancer (SCLC), curative intent surgery is often performed. Previous studies, predominantly from East Asia, reported that high neutrophil to lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR) correlate with poor prognosis in several types of tumors including SCLC. Our aim was to investigate the prognostic value of NLR and PLR in Caucasian patients with resected SCLC, as potential tool to select patients for multimodal treatment including surgery.MethodsConsecutive patients evaluated at three centers between 2000 and 2013 with histologically confirmed and surgically resected SCLC were retrospectively analyzed. NLR and PLR at diagnosis was used to categorize patients into “high” and “low” groups based on receiver operating curve analysis. Univariate and multivariate analyses were used to evaluate the impact of clinical and pathological characteristics on outcome.ResultsThere were a total of 189 patients with a median age of 58 years, and the majority had stage I or II disease. We found a significant correlation between NLR and tumor stage (p = 0.007) and age (p = 0.038). Low NLR (LNLR) was associated with significantly longer overall survival, while PLR had no prognostic impact. There were significant associations between NLR and PLR but not with gender, vascular involvement, tumor necrosis, peritumoral inflammation, or tumor grade.ConclusionPre-operative LNLR may be a favorable prognostic factor in stage I–II SCLCs. PLR is not prognostic in this population. LNLR is easy to assess and can be integrated into routine clinical practice. Further prospective studies are needed to confirm these observations.
Highlights
Small cell lung cancer (SCLC) is a highly aggressive malignancy with a poor prognosis (Siegel, Miller & Jemal, 2017)
Since there were no optimal cut-off values reported in resected limited-stage small cell lung cancer (SCLC) for neutrophil to lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR), time-dependent receiver operating curve (ROC) analysis was used to identify the optimal cut-off values for these parameters according to overall survival (OS) and disease free survival (DFS)
Clinicopathological characteristics Initially, we identified a total of 189 patients that underwent surgical resection: 91, 54, and 44 according to cohorts # 1, #2, and #3, respectively
Summary
Small cell lung cancer (SCLC) is a highly aggressive malignancy with a poor prognosis (Siegel, Miller & Jemal, 2017) In most cases it is diagnosed in advanced-stages, surgical resection is rarely possible and serves little clinical benefit (Lad et al, 1994). Two large cohort study suggests an increased role of surgery in multimodality therapy for early stage SCLC (Combs et al, 2015; Yang et al, 2017) These results might indicate that surgery could be a treatment option even in locally-advanced disease after appropriate patient selection. Predominantly from East Asia, reported that high neutrophil to lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR) correlate with poor prognosis in several types of tumors including SCLC.
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