Pretreatment Neutrophil to Lymphocyte Ratio Is Associated with Poor Survival in Patients with Stage I-III Non-Small Cell Lung Cancer

Background Neutrophil-to-lymphocyte ratio (NLR) has been shown to be a prognostic indicator in several types of cancer. We aimed to investigate the association between NLR and survival in surgery-treated non-small cell lung cancer (NSCLC) patients. Study Design This large retrospective study included 1,245 patients who underwent initial surgery for stage I–III NSCLC at The University of Texas MD Anderson Cancer Center between December 2002 and November 2010. We analyzed the relationship of NLR with clinicopathological variables, local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), recurrence-free survival (RFS), overall survival (OS), and disease-specific survival (DSS) in patients with high or low NLR using Kaplan-Meier method. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to assess the prognostic strength of NLR. Results There was a statistically significant association between the pretreatment NLR and histology type ( P = 0.003) and tumor grade ( P = 0.028). At a median follow-up time of 50.6 months, high NLR was associated with reduced DRFS ( P = 0.011), OS ( P < 0.0001) and DSS ( P = 0.004); it was not associated with LRFS and RFS. Multivariable Cox analysis further revealed that NLR ( P = 0.027), pathologic stage ( P < 0.0001) and lymphovascular invasion ( P < 0.0001) were strong independent predictors for DRFS. NLR was also an independent marker predicting poor OS ( P = 0.002) and DSS ( P = 0.017). Conclusion The pretreatment NLR can serve as a biomarker to predict distant recurrence and death in stage I–III NSCLC patients. Combination of NLR and pathologic stage can better predict the OS and DSS in stage I-II NSCLC patients.