Prognostic models to predict survival in patients with advanced non-small cell lung cancer treated with first-line chemo- or targeted therapy

// Rossana Berardi 1 , Silvia Rinaldi 1 , Matteo Santoni 1 , Thomas Newsom-Davis 2 , Michela Tiberi 3 , Francesca Morgese 1 , Miriam Caramanti 1 , Agnese Savini 1 , Consuelo Ferrini 1 , Mariangela Torniai 1 , Ilaria Fiordoliva 1 , Marc Bower 2 and Stefano Cascinu 1,4 1 Clinica di Oncologia Medica, Universita Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I – GM Lancisi – G Salesi di Ancona, Ancona, Italy 2 Chelsea and Westminster Hospital, London, United Kingdom 3 Chirurgia Toracica, Universita Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I – GM Lancisi – G Salesi di Ancona, Ancona, Italy 4 Oncologia Medica-Universita degli Studi di Modena e Reggio Emilia, Modena, Italy Correspondence to: Rossana Berardi, email: // Keywords : lung cancer; neutrophil to lymphocyte ratio; platinum-base chemotherapy; prognosis; targeted therapy Received : November 11, 2015 Accepted : March 07, 2016 Published : March 23, 2016 Abstract Background: We aimed to assess the prognostic role of neutrophilia, lymphocytopenia and the neutrophil-to-lymphocyte ratio (NLR), and to design models to define the prognosis of patients receiving first-line chemo- or targeted therapy for advanced n on-small cell lung cancer (NSCLC) . Materials and Methods: We retrospectively analysed 401 consecutive patients with advanced NSCLC treated with first line chemo- or targeted therapy. Patients were stratified into two groups with pre-treatment NLR ≥ 3.7 (Group A) vs . < 3.7 (Group B). The best NLR cut-off was identified by ROC curve analysis. Results: At baseline 264 patients had NLR≥3.7 (Group A), whilst 137 had lower NLR (Group B). Median OS was 10.8 months and 19.4 months in the two groups ( p < 0.001), while median PFS was 3.6 months and 5.6 months, respectively ( p = 0.012). At multivariate analysis, ECOG-PS≥2, stage IV cancer, non-adenocarcinoma histology, EGFR wild-type status and NLR were predictors of worse OS. Stage IV cancer, wild type EGFR status and NLR≥3.7 were independent prognostic factors for worse PFS. Patients were stratified according to the presence of 0-1 prognostic factors (8%), 2-3 factors (73%) and 4-5 factors (19%) and median OS in these groups was 33.7 months, 14.6 months and 6.6 months, respectively ( p < 0.001). Similarly, patients were stratified for PFS based on the presence of 0-1 prognostic factor (15%), 2 factors (41%) and 3 factors (44%). The median PFS was 8.3 months, 4.6 months and 3.3 months respectively ( p < 0.001). Conclusion: Pre-treatment NLR is an independent prognostic factor for patients with advanced NSCLC treated with first-line therapies.