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)

Abstract

BACKGROUND: Currently, there is no single validated biomarker which can prognosticate survival in patients with stage IV non-small cell lung cancer (NSCLC). This study examines the prognostic significance of four biomarkers: neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and advanced lung cancer inflammation index (ALI) in patients with stage IV NSCLC. METHODS: This study aimed to establish the relationship between NLR, LMR, PLR, ALI and overall survival (OS) at baseline and post first cycle of treatment using Cox univariate PH models. We also studied these biomarkers in the elderly (age ≥70 years). Clinical data was sourced from Calvary Mater Newcastle between 2010 and 2015. RESULTS: Baseline NLR, PLR, LMR and ALI showed strong association with OS. Five unit increase in NLR and PLR was associated with an 11% and 0.5% increase in the hazard of death respectively while 1 unit increase in ALI resulted in 4% increase in hazard of death. Five unit increase in LMR was associated with a 50% reduction in hazard of death. Post-treatment NLR and low ALI correlated with shorter OS but no statistically significant relationship could be demonstrated for PLR nor LMR. Similar prognostic trends were noted for elderly. CONCLUSIONS: High NLR, high PLR, low LMR and low ALI at baseline are significantly associated with poor OS. High NLR and low ALI are significantly associated with poor OS post treatment. Findings are similar regardless of age.