Prognostic value of the neutrophil-to-lymphocyte ratio and primary tumor location in epidermal growth factor receptor-mutated metastatic non-small cell lung cancer.

Abstract

Few studies have reported on the relationship between complete blood count (CBC) parameters and progression-free survival (PFS) in nonsmall cell lung cancer (NSCLC) treated with tyrosine kinase inhibitors (TKIs). Evaluate the prognostic value of pretreatment in patient CBC with advanced NSCLC when treated with epidermal growth factor receptor-TKIs as first-line to third-line therapy. Settings and Design: We retrospectively analyzed 190 patients receiving TKIs with metastatic NSCLC harboring an exon del19, 21 L858R mutations, or other rare mutations. Pretreatment blood data were obtained from electronic medical records. Patient imaging results were used to identify tumor location. Methods: Baseline clinical characteristics were compared by Pearson's Chi-square and Student's t-tests. Cox regression analyses were used to evaluate the prognostic value of peripheral blood parameters on PFS. All prognostic factors were explored with multivariable regression. Patients with high Neu% (13.0 vs. 18.8 months, P= 0.003), Neu (12.0 vs. 14.5 months, P = 0.014), and neutrophil-to-lymphocyte ratio (NLR) (7.0 vs. 15.2 months, P < 0.001) had worse PFS. In contrast, patients with higher Lym (13.0 vs. 16.5 months, P = 0.012) and Lym% (8.8 vs. 15.3 months, P < 0.001) showed better PFS. In addition, tumor location was also an important factor for prognosis (11.6 vs. 14.3 months, P = 0.003). Our data indicated that Lym, LLym%, HNeu, HNeu%, and HNLR were associated with poor prognosis in NSCLC patients treated with TKIs. NLR and primary tumor location were both identified as independent risk indicators for worse PFS based on multivariate analysis.