DOI: https://doi.org/10.14710/jbtr.v9i3.19403

High Pre-treatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) Shows Lower Progressive-free Survival and Overall Survival in Tyrosine Kinase Inhibitor-treated Lung Adenocarcinoma

Department of Pulmonology and Respiratory Medicine, Universitas Lambung Mangkurat, Indonesia

Received: 16 Jul 2023; Revised: 14 Dec 2023; Accepted: 22 Dec 2023; Available online: 31 Dec 2023; Published: 31 Dec 2023.
Open Access Copyright (c) 2023 Journal of Biomedicine and Translational Research
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:
Abstract

Background: The role of Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as an easy and inexpensive prognostic examination modality has different results. While the combination of the two has never been done.

Objective: This study investigated the association between NLR/PLR and outcomes in advanced lung adenocarcinoma Epidermal Growth Factor Receptor (EGFR) mutation-positive with Tyrosine Kinase Inhibitor (TKI) treatment.

Methods: This retrospective study enrolled 40 medical records of lung adenocarcinoma patients treated with TKI in Ulin General Hospital from 2017-2019, with follow-up until April 1, 2021. A receiver operating curve (ROC) was performed to determine the optimal cut-off and parallel tests of NLR/PLR combination. The Kaplan-Meier was used to evaluate the impact on progressive-free survival (PFS) and overall survival (OS).

Results: The optimal cut-off was 6.25 for NLR and 451.5 for PLR with sensitivity and specificity of PFS (31.6%, 100%, and 18.4%, 100%) and OS (32.4%, 100% and 8.9%, 100%) (AUC 0.362, 0.329 and 0.482, 0.477) respectively. Patients in NLR <6.25 and PLR <451.5 groups presented longer PFS (10 months, 95% CI:7.783 -12.217, vs. 8 months, 2.908-13.092, p=0.821; 10 months, 7.508 – 12.492 vs. 9 months, 6.434-11.566, p=0.513) and OS (20 months, 14.017-25.983 vs.16 months, 11.474-20.526, p=0.378; 20 months, 14.629-25.371 vs. 14 months, 3.735-24.265, p=0.382) but not significantly correlated.

Conclusion: High pre-treatment NLR and PLR showed shorter PFS and OS, although they did not appear as a prognostic marker for PFS and OS of EGFR-mutant lung adenocarcinoma treated with TKI.

Fulltext View|Download
Keywords: Lung Adenocarcinoma, NLR, PLR, progressive-free survival, and overall survival

Article Metrics:

Article Info
Section: Original Research Articles
Language : EN
Recent articles
Comparison of SARS-CoV-2 Variant Screening and Whole Genome Sequencing at an Indonesian Tertiary Hospitals Comparative Analysis of Kidney Histomorphometry Utilizing Two Distinct Image Processing Software Analysis Of Clerodendrum inerme Plant Compounds as Anti Diabetes Mellitus Through Network Pharmacology Approach Recalcitrant Incomplete Secukinumab Administration in a Psoriasis Patient Exploring Systemic Lupus Erythematosus Pathogenesis through Animal Models: A Systematic Review of Humanized and Pristane-Induced Lupus Mice More recent articles
  1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209–249
  2. Shi Y, Au JSK, Thongprasert S, et al. A Prospective, Molecular Epidemiology Study of EGFR Mutations in Asian Patients with Advanced Non–Small-Cell Lung Cancer of Adenocarcinoma Histology (PIONEER). Journal of Thoracic Oncology 2014; 9: 154–162
  3. Ha SY, Choi SJ, Cho JH, et al. Lung cancer in never-smoker Asian females is driven by oncogenic mutations, most often involving EGFR. Oncotarget 2015; 6: 5465
  4. Greenhalgh J, Dwan K, Boland A, et al. First‐line treatment of advanced epidermal growth factor receptor (EGFR) mutation positive non‐squamous non‐small cell lung cancer. Cochrane Database of Systematic Reviews; 2016. Epub ahead of print 25 May 2016. DOI: 10.1002/14651858.CD010383.PUB2
  5. Bergqvist M, Christensen HN, Wiklund F, et al. Real world utilization of EGFR TKIs and prognostic factors for survival in NSCLC during 2010–2016 in Sweden: A nationwide observational study. Int J Cancer 2020; 146: 2510–2517
  6. Kang J, Chang Y, Ahn J, et al. Neutrophil-to-lymphocyte ratio and risk of lung cancer mortality in a low-risk population: A cohort study. Int J Cancer 2019; 145: 3267–3275
  7. Mandaliya H, Jones M, Oldmeadow C, et al. Prognostic biomarkers in stage IV non-small cell lung cancer (NSCLC): neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and advanced lung cancer inflammation index (ALI). Transl Lung Cancer Res 2019; 8: 886
  8. Guo W, Cai S, Zhang F, et al. Systemic immune-inflammation index (SII) is useful to predict survival outcomes in patients with surgically resected non-small cell lung cancer. Thorac Cancer 2019; 10: 761–768
  9. Amaral SR, Moura MC, Carvalho J, et al. Prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors. Annals of Oncology 2019; 30: i3
  10. Deng C, Zhang N, Wang Y, et al. High systemic immune-inflammation index predicts poor prognosis in advanced lung adenocarcinoma patients treated with EGFR-TKIs. Medicine (United States); 98. Epub ahead of print 1 August 2019. DOI: 10.1097/MD.0000000000016875
  11. Wu S-G, Chang Y-L, Yu C-J, et al. Lung adenocarcinoma patients of young age have lower EGFR mutation rate and poorer efficacy of EGFR tyrosine kinase inhibitors. ERJ Open Res 2017; 3: 92–2016
  12. Diem S, Schmid S, Krapf M, et al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer 2017; 111: 176–181
  13. Zheng Y, Chen Y, Chen J, et al. Combination of Systemic Inflammation Response Index and Platelet-to-Lymphocyte Ratio as a Novel Prognostic Marker of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy. Front Oncol 2019; 0: 914
  14. Midha A, Dearden S, McCormack R. EGFR mutation incidence in non-Small-cell lung cancer of adenocarcinoma histology: A systematic review and global map by ethnicity (mutMapII). Am J Cancer Res 2015; 5: 2892–2911
  15. Madeddu C, Mantovani G, Gramignano G, et al. Muscle wasting as main evidence of energy impairment in cancer cachexia: Future therapeutic approaches. Future Oncology 2015; 11: 2697–2710
  16. Van Der Meij BS, Schoonbeek CP, Smit EF, et al. Pre-cachexia and cachexia at diagnosis of stage III non-small-cell lung carcinoma: an exploratory study comparing two consensus-based frameworks. Epub ahead of print 2021. DOI: 10.1017/S0007114512004527
  17. Cohen S, Nathan JA, Goldberg AL. Muscle wasting in disease: Molecular mechanisms and promising therapies. Nat Rev Drug Discov 2014; 14: 58–74
  18. Li D, Yuan X, Liu J, et al. Prognostic value of prognostic nutritional index in lung cancer: a meta-analysis. J Thorac Dis 2018; 10: 5298
  19. Yoon HY, Ryu JS, Sim YS, et al. Clinical significance of EGFR mutation types in lung adenocarcinoma: A multi-centre Korean study. PLoS One; 15. Epub ahead of print 1 February 2020. DOI: 10.1371/journal.pone.0228925
  20. Song Q, Shang J, Yang Z, et al. Identification of an immune signature predicting prognosis risk of patients in lung adenocarcinoma. J Transl Med 2019; 17: 70

Last update:

No citation recorded.

Last update:

No citation recorded.