Neutrophil-to-Lymphocyte Ratio Predicts Overall Survival of Advanced Non-Small Cell Lung Cancer Harboring Mutant Epidermal Growth Factor Receptor

Seigo Minami, Yoshitaka Ogata, Shouichi Ihara, Suguru Yamamoto, Kiyoshi Komuta


Background: Neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) have been demonstrated to be prognostic biomarkers in various cancers, including non-small cell lung cancer (NSCLC). However, little has been known about these two ratios for a specific population of NSCLC harboring active epidermal growth factor receptor (EGFR) mutation.

Methods: We retrospectively reviewed electrical medical records of 152 patients who met the following criteria: NSCLC harboring mutant EGFR, EGFR-tyrosine kinase inhibitor (EGFR-TKI) monotherapy initiated between October 2007 and February 2017 at our hospital, stage III-IV or post-surgical recurrence. We compared overall survival (OS) and progression-free survival (PFS) between dichotomized groups by the optimal cut-off points of the two biomarkers. Univariate and multivariate Cox hazard analyses also searched for prognostic factors of survival time.

Results: OSs of NLR < 2.11 (median 38.6 vs. 24.1 months, P < 0.01) and LMR >=5.09 (median 39.4 vs. 26.4 months, P < 0.01) were significantly longer than those of NLR >= 2.11 and LMR < 5.09. Multivariate analyses found lower NLR (hazard ratio (HR) 1.07, 95% CI: 1.01 - 1.14; P = 0.03) as an independent prognostic factor for longer OS, in addition to Eastern Cooperative Oncology Group performance status 0 - 1, first-line EGFR-TKI, higher serum sodium concentration and lower lactate dehydrogenase. However, LMR was not detected as a significant prognostic factor for OS. None of these two biomarkers was selected as an independent prognostic factor for PFS.

Conclusions: This study demonstrated that elevated NLR is an independent prognostic factor for poor survival of patients with EGFR mutant NSCLC. NLR is a useful and simple biomarker for these patients.

World J Oncol. 2017;8(6):180-187


Neutrophil-to-lymphocyte ratio; Lymphocyte-to-monocyte ratio; Non-small cell lung cancer; Epidermal growth factor receptor mutation; Epidermal growth factor receptor tyrosine kinase inhibitors; Overall survival; Progression-free survival; Retrospective an

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