Abstract

Crispin Hiley^1,2, Anshu Punjabi³, Emma Barrett³, Andrew Cheng⁴, Arafat Mulla³, Gerard Walls⁵, David Johnston⁶, Jonathan McAleese⁶, Karen Moore⁷, Jonathan Hicks⁷, Kevin Blyth⁷, Mary Denholm⁸, Lavina Magee⁸, David Gilligan⁸, Sabrina Silverman², Muneed Qureshi⁹, Hugh Clinch¹⁰, Matthew Hatton⁹, Lara Philips¹¹, Sean Brown¹², Mary O'Brien¹¹, Fiona Macdonald¹¹, Corinne Faivre-Finn^13,14, Matthew Evison³

¹University College London, CRUK Lung Cancer Centre of Excellence, London, United Kingdom; ²University College London Hospital, Oncology, London, United Kingdom; ³Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom; ⁴Manchester University NHS Foundation Trust, , Wythenshawe Hospital, London, United Kingdom; ⁵Queen’s University Belfast, Oncology, Belfast, United Kingdom; ⁶Cancer Centre Belfast City Hospital, Oncology, Belfast, United Kingdom; ⁷NHS Greater Glasgow & Clyde, Oncology, Glasgow, United Kingdom; ⁸Cambridge University Hospitals NHS Trust, Oncology, Cambridge, United Kingdom; ⁹Weston Park Hospital, Oncology, Sheffield, United Kingdom; ¹⁰The University of Sheffield Medical School, Oncology, Sheffield, United Kingdom; ¹¹Royal Marsden Hospital, Oncology, London, United Kingdom; ¹²The University of Manchester, Oncology, Manchester, United Kingdom; ¹³The University of Manchester, CRUK Lung Cancer Centre of Excellence, Manchester, United Kingdom; ¹⁴The Christie NHS Foundation Trust, Clinical Oncology, Manchester, United Kingdom

Neutrophil-Lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC pre and post curative-intent radiotherapy (RT) for NSCLC on disease recurrence and overall survival.

A retrospective study of consecutive patients who underwent curative-intent RT for NSCLC across 9 sites in the UK from 01/10/2014 to 01/10/2016. A multivariate analysis was performed to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for co-founding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival (OS) within 2 years of treatment.

425 patients were identified with complete blood parameter values. Higher pre-NLR, post-NLR and change in NLR plus lower post ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR >2.5 (OR 1.71, 95%CI 1.06-2.79, p< 0.05), a post-NLR >5.5 (OR 2.36, 95%CI 1.49-3.76, p< 0.001], a change in NLR >3.6 (OR 2.41, 95%CI 1.5-3.91, p<0.001) and a post-ALC <0.8 (OR 2.86, 95%CI 1.76-4.69, p <0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for cofounding factors. None of the NLR/ALC parameters were independent predictors of disease recurrence.

NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post treatment to inform the intensity of surveillance protocols.