Impact of the neutrophil-to-lymphocyte ratio on patients with locally advanced non-small cell lung cancer who suffer radiation pneumonitis during the course of induction chemoradiotherapy followed by surgery

Yujiro Kubo; Hiromasa Yamamoto; Kei Matsubara; Kohei Hashimoto; Shin Tanaka; Kazuhiko Shien; Ken Suzawa; Kentaroh Miyoshi; Mikio Okazaki; Seiichiro Sugimoto; Kuniaki Katsui; Takao Hiraki; Katsuyuki Kiura; Shinichi Toyooka

doi:10.1007/s00595-024-02816-y

Impact of the neutrophil-to-lymphocyte ratio on patients with locally advanced non-small cell lung cancer who suffer radiation pneumonitis during the course of induction chemoradiotherapy followed by surgery

Surg Today. 2024 Mar 7. doi: 10.1007/s00595-024-02816-y. Online ahead of print.

Authors

Yujiro Kubo¹, Hiromasa Yamamoto^{2

3}, Kei Matsubara⁴, Kohei Hashimoto⁵, Shin Tanaka⁴, Kazuhiko Shien⁶, Ken Suzawa⁵, Kentaroh Miyoshi⁵, Mikio Okazaki¹, Seiichiro Sugimoto⁴, Kuniaki Katsui⁷, Takao Hiraki⁸, Katsuyuki Kiura⁹, Shinichi Toyooka¹

Affiliations

¹ Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
² Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. h.yamamoto@med.shimane-u.ac.jp.
³ Center for Clinical Genetics and Genomic Medicine, Shimane University Hospital, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan. h.yamamoto@med.shimane-u.ac.jp.
⁴ Organ Transplant Center, Okayama University Hospital, Okayama, Japan.
⁵ Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
⁶ Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
⁷ Division of Radiation Oncology, Department of Radiology, Kawasaki Medical School, Kurashiki, Japan.
⁸ Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
⁹ Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan.

PMID: 38451313
DOI: 10.1007/s00595-024-02816-y

Abstract

Purpose: Radiation pneumonitis (RP) is an obstacle for patients after surgery following induction chemoradiotherapy for locally advanced non-small cell lung cancer (LA-NSCLC). We performed a comparative analysis of the association between clinicopathological factors, including the neutrophil-to-lymphocyte ratio (NLR) and prognosis, in LA-NSCLC patients with or without RP during induction chemoradiotherapy followed by surgery.

Methods: The subjects of this analysis were 168 patients undergoing trimodality therapy for LA-NSCLC between January, 1999 and May, 2019. Patients were divided into two groups: the RP group (n = 41) and the non-RP group (n = 127). We compared the clinicopathological factors including the NLR between the groups and analyzed the association between the NLR and prognosis.

Results: The RP group had more patients with tumors located in the lower lobe, more bilobar resections, shorter operative times, no implementation of postoperative adjuvant chemotherapy, and a higher postoperative NLR than the non-RP group. There were no significant differences in serious postoperative complications and the prognosis. Patients with a low postoperative NLR had a significantly better prognosis in the non-RP group, and a trend toward a better prognosis even in the RP group.

Conclusion: Postoperative NLR may be a useful prognostic factor, even for patients who suffer RP after trimodality therapy for LA-NSCLC.

Keywords: Induction chemoradiotherapy; Neutrophil-to-lymphocyte ratio; Non-small cell lung cancer; Radiation pneumonitis.