Prognostication of non-small cell lung cancer with concurrent chemoradiation treatment using neutrophil-to-lymphocyte ratio.

purposeWe evaluated neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor in patients with stage III unresectable non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation (CRT). Furthermore, we examined neutrophil and lymphocyte changes to determine their contributions to NLR variation over time. MATERIALS AND

methodsA retrospective review was performed that included 262 patients diagnosed with stage III unresectable NSCLC from 2005 to 2020 who received concurrent CRT with a 60 Gy or 66 Gy in 30 fractions radiotherapy regimen. Pre-CRT NLR, lymphocyte nadir NLR, post-CRT NLR at 1 month ± 2-week intervals up to 6 months relative to the end of CRT, and NLR fold-change were calculated. The primary endpoint was overall survival.

resultsOf the examined parameters, high NLR had the most consistently high prognostic value for poorer outcomes for all 3 endpoints in the 6-month period post-CRT, with the highest hazard ratios (HRs) at 3 to 4 months. This was associated with a decrease in neutrophils from 3 to 4 months, while NLR and lymphocytes were relatively stable. Several other parameters at 4 months, including individual cell counts and NLR fold-change (relative to the lymphocyte nadir), were associated with high HRs for mortality.

conclusionOur study suggests that a window of time at 3 to 4 months post-CRT exists for when NLR and related hematologic parameters demonstrate increased prognostic value. This period may represent an area for further investigation as a potential opportunity for risk stratification with possible implications for surveillance and treatment.