Prognostic Value of Delta Inflammatory Biomarker-based Nomograms in Patients with Inoperable Locally Advanced NSCLC

Abstract

Inflammation plays critical roles in tumor growth and progression, and can be adversely affected by chemotherapy and radiotherapy. However, there have been few studies on the prognostic value of delta (Δ) inflammatory biomarkers before and after chemoradiotherapy in patients with locally advanced non-small-cell lung cancer (LA-NSCLC). In this study, pre/post-treatment and Δ inflammatory biomarkers of 370 patients who were diagnosed as having inoperable LA-NSCLC in Shandong Cancer Hospital between January 2005 and January 2016 were analyzed. Nomograms were then established for predicting prognosis. Median overall survival (OS) and progression free survival (PFS) for all patients were 28.1 (range 1.9–129.0) months and 11.1 (range 1.7–58.7) months, respectively. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) significantly increased and the lymphocyte-to-monocyte ratio (LMR) significantly decreased during the concurrent chemoradiotherapy course (P<0.001, P<0.001, and P<0.001, respectively). Multivariate analysis revealed that pre-LMR, ΔNLR, and minimum absolute lymphocyte counts were independent predictors of OS (P=0.027, P=0.012, and P=0.015, respectively) and post-LMR, post-NLR, and ΔNLR were independent predictors of PFS (P=0.014, P=0.001, and P=0.036, respectively). Nomograms for OS and PFS were established by combining all significant inflammatory markers and clinicopathological characteristics. The concordance indexes for OS and PFS were 0.709 and 0.688, respectively. Post-treatment and Δ inflammatory biomarkers may have more prognostic significance than baseline measurements of inflammatory biomarkers in LA-NSCLC patients. The proposed nomograms based on the dynamic inflammatory biomarkers and clinicopathological factors are practical and widely available for evaluating the prognosis of patients with inoperable LA-NSCLC.