Prognostic models to predict survival in patients with advanced non-small cell lung cancer treated with first-line chemo- or targeted therapy

• Published in: Oncotarget 2016-05, Vol.7 (18), p.26916-26924
• Main Authors: Berardi, Rossana, Rinaldi, Silvia, Santoni, Matteo, Newsom-Davis, Thomas, Tiberi, Michela, Morgese, Francesca, Caramanti, Miriam, Savini, Agnese, Ferrini, Consuelo, Torniai, Mariangela, Fiordoliva, Ilaria, Bower, Marc, Cascinu, Stefano
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Area Under Curve; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Clinical Research Papers; Disease-Free Survival; ErbB Receptors - genetics; Female; Humans; Kaplan-Meier Estimate; Leukocyte Count; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lymphocytes; Male; Middle Aged; Multivariate Analysis; Neutrophils; Prognosis; Retrospective Studies; Risk Factors; ROC Curve
• ISSN: 1949-2553; 1949-2553
• DOI: 10.18632/oncotarget.8309

We aimed to assess the prognostic role of neutrophilia, lymphocytopenia and the neutrophil-to-lymphocyte ratio (NLR), and to design models to define the prognosis of patients receiving first-line chemo- or targeted therapy for advanced non-small cell lung cancer (NSCLC). We retrospectively analysed 401 consecutive patients with advanced NSCLC treated with first line chemo- or targeted therapy. Patients were stratified into two groups with pre-treatment NLR ≥ 3.7 (Group A) vs. < 3.7 (Group B). The best NLR cut-off was identified by ROC curve analysis. At baseline 264 patients had NLR≥3.7 (Group A), whilst 137 had lower NLR (Group B). Median OS was 10.8 months and 19.4 months in the two groups (p < 0.001), while median PFS was 3.6 months and 5.6 months, respectively (p = 0.012). At multivariate analysis, ECOG-PS≥2, stage IV cancer, non-adenocarcinoma histology, EGFR wild-type status and NLR were predictors of worse OS. Stage IV cancer, wild type EGFR status and NLR≥3.7 were independent prognostic factors for worse PFS. Patients were stratified according to the presence of 0-1 prognostic factors (8%), 2-3 factors (73%) and 4-5 factors (19%) and median OS in these groups was 33.7 months, 14.6 months and 6.6 months, respectively (p < 0.001). Similarly, patients were stratified for PFS based on the presence of 0-1 prognostic factor (15%), 2 factors (41%) and 3 factors (44%). The median PFS was 8.3 months, 4.6 months and 3.3 months respectively (p < 0.001). Pre-treatment NLR is an independent prognostic factor for patients with advanced NSCLC treated with first-line therapies.