The Neutrophil to Lymphocyte Ratio May Predict Benefit from Chemotherapy in Lung Cancer

Background/aims: The objectives of this study were to evaluate the impact of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) on overall survival (OS) and to explore the value of changes in the NLR and PLR with treatment as a response indicator.

Methods: A total of 934 patients were eligible for retrospective analysis between 2008 and 2014. The pretreatment and post-treatment PLR and NLR in all patients were calculated based on complete blood counts. Univariate and multivariate Cox regression analyses were performed to determine the associations of the PLR and NLR with OS.

Results: The pretreatment NLR and PLR were correlated with different disease status and response to chemotherapy. Patients with lower NLR and PLR had a significantly better complete response (CR) rate to chemotherapy versus those with a higher NLR and PLR (p< 0.001). The NLR and PLR were sustained in patients who obtained a CR compared with moderate or poor response patients. The lower NLR of pretreatment was independently associated with a favourable prognosis in whole patients with lung cancer (HR: 0.69, 95% CI, 0.55-0.85, p< 0.001). In the patients under control after chemotherapy, the NLR of post-chemotherapy had a greater impact on survival, and the low NLR level maintained during chemotherapy was identified a predictor for favourable survival. PLR was not an independent prognostic indicator in the whole cohort or any subgroups.

Conclusion: Our results suggested that NLR was well-connected with outcomes and response to chemotherapy in patients with lung cancer. As a response indicator, NLR may predict benefit from chemotherapy and improve patient selection.