Abstract
ObjectiveInflammation plays a crucial role in tumorigenesis and progression. Our purpose was to investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII), and develop a nomogram to predict the cancer-specific survival (CSS) and disease-free survival (DFS) of stage I lung adenocarcinoma patients.Methods1431 patients undergoing surgical resection with pathologically confirmed stage I lung adenocarcinoma were reviewed. The optimal cut-off values for NLR, SII, and SIRI were defined by the receiver operating characteristic (ROC) curve. Cox proportional hazards regression analyses were performed to recognize factors significantly correlated with CSS and DFS to construct the nomogram. The value of adjuvant chemotherapy on model-defined high-risk and low-risk patients was further explored.ResultsThe cohort had a median follow-up time of 63 months. Multivariate analysis revealed that higher NLR (≥2.606), higher SIRI (≥0.705), higher SII (≥580.671), later T stage, histological pattern with solid or micropapillary components and radiologic features with solid nodules were significantly associated with worse CSS and DFS. The concordance index (C-index) of the nomogram established by all these factors was higher than that of the TNM staging system both in CSS (validation set 0.778 vs 0.652) and DFS (validation set 0.758 vs 0.695). Furthermore, the value of the established nomogram on risk stratification in stage I lung adenocarcinoma patients was validated.ConclusionsHigher NLR, SII and SIRI pretreatment were associated with worse survival outcomes. A practical nomogram based on these three inflammatory biomarkers may help clinicians to precisely stratify stage I lung adenocarcinoma patients into high- and low-risk and implement individualized treatment.
Highlights
Lung cancer is the first leading cause of cancer deaths worldwide [1], with lung adenocarcinoma accounting for the majority
Records for a total of 1868 Patients with stage I lung adenocarcinoma who received surgical resection were identified for this study
A total of 1431 patients pathologically diagnosed as resected lung adenocarcinoma were included (Supplementary Figure 1)
Summary
Lung cancer is the first leading cause of cancer deaths worldwide [1], with lung adenocarcinoma accounting for the majority. 21% of patients are diagnosed at stage I. The 5-year survival rate is about 73%-90% [2, 3]. Surgical resection remains the standard of care for stage I lung adenocarcinoma. The cumulative incidence of 5-year localrecurrence and distant-metastasis is approximately 12%-15% and 17%-22% [4, 5]. Stage IB patients with high-risk factors may be considered with adjuvant chemotherapy on the basis of National Comprehensive Cancer Network (NCCN) guidelines [6]. How to select patients with a high risk of recurrence and metastasis is one of the academic research hotspots. Many prognostic factors have been summarized to recognize highrisk individuals, such as tumor size, wedge resection, differentiation grade, and visceral pleural involvement [7]. Patients’ immune and inflammatory indices are not included, which may be the same critical
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