Systemic Inflammation-Immune Status Predicts Survival in Stage III-N2 Non-Small Cell Lung Cancer

Abstract

Systematic inflammation-immune status has been thought to play a crucial role in tumorigenesis and progress. This study evaluated the prognostic value of systematic inflammation-immune status in patients with resected non-small cell lung cancer with pathological N2 nodal involvement (pN2-NSCLC). The relation between the preoperative systematic inflammation-immune score (SIS), defined as preoperative peripheral platelet count× neutrophil count/lymphocyte count, and prognosis was tested in a retrospective study of 660 consecutive patients with completed resected pN2-NSCLC and validated by a prospective study of 189 patients enrolled (NCT00880971). SIS of 650× 109 was an optimal cutoff point to stratify the patients with pN2-NSCLC into high (>650× 109) and low (≤650× 109) SIS groups in the training cohort. Univariate and multivariate analyses revealed that the SIS was an independent predictor for overall survival, disease-free survival, and distant metastasis-free survival. In the validation group, high SIS (>650× 109) predicted poor 5-year overall survival (hazard ratio [HR], 2.418; P=.006), disease-free survival (HR, 1.542; P= .042), and distant metastasis-free survival (HR, 1.682; P= .024). In addition to the number of positive lymph nodes, the area under the receiver operating characteristic curve of the SIS for outcomes was higher than the neutrophil count-to-lymphocyte count ratio, platelet count-to-lymphocyte count ratio, and other conventional clinicopathologic indices. The preoperative SIS is a more sensitive survival predictor than most of the other conventional clinical indices and may aid in more accurately stratifying patients for risk assessment and treatment decision.