Pretreatment neutrophil-to-lymphocyte ratio is a predictive biomarker for EGFR TKI-treated patients with advanced EGFR-mutant Non-small cell lung cancer

Cong Xu; Xiaojun Yao; Ting Li; Jue Wang; Bo An; Jing Wang; Xinbing Sui; Elaine Lai-Han Leung; Qibiao Wu

doi:10.21037/tcr.2020.02.28

Pretreatment neutrophil-to-lymphocyte ratio is a predictive biomarker for EGFR TKI-treated patients with advanced EGFR-mutant Non-small cell lung cancer

Transl Cancer Res. 2020 Apr;9(4):2875-2883. doi: 10.21037/tcr.2020.02.28.

Authors

Cong Xu^#^{1

2}, Xiaojun Yao^#^{1

2}, Ting Li^{1

2}, Jue Wang^{1

2}, Bo An^{1

2}, Jing Wang^{1

2}, Xinbing Sui^{3

4}, Elaine Lai-Han Leung^{1

2}, Qibiao Wu^{1

2}

Affiliations

¹ State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau 999078, China.
² Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau 999078, China.
³ Department of Cancer Pharmacology, Holistic Integrative Pharmacy Institutes, College of Medicine, Hangzhou Normal University, Hangzhou 311121, China.
⁴ Department of Medical Oncology, Holistic Integrative Oncology Institutes and Holistic Integrative Cancer Center of Traditional Chinese and Western Medicine, the Affiliated Hospital of Hangzhou Normal University, College of Medicine, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China.

^# Contributed equally.

Abstract

Background: Neutrophil-lymphocyte ratio (NLR) has been reported as a prognostic biomarker in various cancers, but its prognostic value for advanced epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) treated with EGFR tyrosine kinase inhibitors (TKIs) remains unclear. To address this issue, we performed a retrospective study to investigate the clinical value of NLR in these patients.

Methods: All data were collected from medical records. Sixty-five cases with stage IIIB-IVB EGFR-mutant NSCLC treated with EGFR-TKIs were enrolled. The pretreatment NLR was analyzed for associations with disease control rate (DCR) and progression-free survival (PFS). The primary outcomes of interest were DCR and PFS. All the data were analyzed using SPSS 23.0. The PFS curves were plotted by Kaplan-Meier analysis and log-rank test. Univariate and multivariate Cox regression analyses were used to determine the factors affecting PFS.

Results: The results indicated that, compared with those with lower NLR (<2.57), the patients with a higher NLR (≥2.57) showed a significantly shorter PFS (8.8 vs. 12.2 months, P<0.01), and decreased DCR by the end of 8, 10 months after TKIs treatment (62.5% vs. 93.3%, P=0.014; 38.5% vs. 77.8%, P=0.037). COX multivariate analysis showed that NLR was an independent prognostic factor for PFS (P<0.001).

Conclusions: Elevated NLR is significantly associated with lower DCR, shorter PFS, and might act as a meaningful biomarker for predicting the efficacy of TKIs treatment and the prognosis of advanced EGFR-mutant NSCLC. High-quality prospective clinical trials with longer follow-up are needed to further confirm the results.

Keywords: Non-small cell lung cancer (NSCLC); correlation; epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI); neutrophil-lymphocyte ratio (NLR); predictive biomarker.