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Right arrow Lung - cancer

J Thorac Cardiovasc Surg 2009;137:425-428
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Neutrophil/lymphocyte ratio and its association with survival after complete resection in non–small cell lung cancer

Khaled M. Sarraf, MRCSa, Elizabeth Belcher, FRCSa, Evgeny Raevsky, MDa, Andrew G. Nicholson, FRCPathb, Peter Goldstraw, FRCSa, Eric Lim, FRCS (C-Th)a,*

a Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
b Department of Histopathology, Royal Brompton Hospital, London, United Kingdom

Received for publication February 22, 2008; revisions received April 16, 2008; accepted for publication May 15, 2008.

* Address for reprints: Eric Lim, FRCS (C-Th), Academic Division of Thoracic Surgery, Royal Brompton Hospital, Sydney St, London SW3 6NP, United Kingdom. (Email: e.lim{at}rbht.nhs.uk).

Objective: Increasing neutrophil/lymphocyte ratios on preoperative blood tests have been associated with worse survival after resection of colorectal cancer. We sought to determine factors associated with increasing neutrophil/lymphocyte ratios and the stage-adjusted prognostic effect in patients undergoing resection for non–small cell lung cancer.

Methods: We performed a retrospective review of patients undergoing complete resection for non–small cell lung cancer between 1999 and 2005. Data acquisition was through patient medical records, blood results recorded on admission before surgical intervention, and follow-up by National Health Service database searches and hospital records. Cox proportional hazards regression was used to estimate the effect of neutrophil/lymphocyte ratio on stage-adjusted survival.

Results: During the study period, 178 patients underwent pulmonary resection. Of 177 patients, the majority were male 104 (59%), with a mean age of 63 years (standard deviation, 10 years). The median follow-up time was 29 months (interquartile range, 8–56 months), and overall survival was 83% and 54% at 1 and 5 years, respectively. Higher stage was the only factor found to be associated with increasing neutrophil/lymphocyte ratios (P = .019). Total white cell count (P = .990) and neutrophil count (P = .490), age (P = .290), and cell type (P = .490) were not significant predictors of mortality. On multivariable analysis after adjusting for stage, increasing neutrophil/lymphocyte ratios (hazard ratio, 1.10; 95% confidence interval, 1.03–1.17; P = .004) remained an independent prognostic indicator.

Conclusions: Increasing preoperative neutrophil/lymphocyte ratios are associated with higher stage but remain an independent predictor of survival after complete resection for primary lung cancer and are a potential biomarker to stratify high risk of death in patients with stage I disease.

Abbreviation and Acronym NLR = neutrophil/lymphocyte ratio






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