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K.H. Kang

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    P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      P1.03-026 - Prognostic Value of Pre-Treatment Neutrophil:Lymphocyte Ratio and Platelet:Lymphocyte Ratio in Stage III NSCLC (ID 3129)

      09:30 - 17:00  |  Author(s): K.H. Kang

      • Abstract
      • Slides

      Stage III locally advanced NSCLC is a challenging disease with poor outcome. The currently accepted treatment consideration is definitive chemo-radiation with the addition of surgery for selected patients. There are few if any reliable predictors for treatment outcome in these patients. Recent studies have suggested that the pre-treatment presence of systemic inflammatory response, as indicated by the neutrophil/lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), may be useful prognostic factors. Thus, we undertook this retrospective analysis of stage III NSCLC to examine the role of pre-treatment NLR and PLR as a predictor of outcome and also to compare the value of surgery in addition to chemo and radiotherapy.

      A total of 107 patients with stage III disease were identified from our institutional lung cancer database. Patients were staged as per AJCC system, 7th edition. Patients with N0 or N1 status were excluded. The following information was collected from their electronic medical records as available: age, gender, substage, histology, grade, baseline blood work, and treatment type. NLR was defined as the ratio between neutrophil and lymphocyte count and PLR was defined as ratio between platelet and lymphocyte count, measured prior to any cytotoxic therapy. We studied both median value and NLR ≥5 in order to categorize patients as high- or low-NLR group. Median PLR was used to categorize as high- or low-PLR group. The recurrence-free (RFS) and overall (OS) cumulative probability of survival was calculated by the Kaplan-Meier method, and the difference was assessed by the log-rank test.

      The median age at diagnosis was 62 years (range: 44 - 87) and 50% (n=53) were male. The median follow-up was 25 months. The most common histology was adenocarcinoma (60%, n=64) followed by squamous cell cancer (19%, n=20), large cell carcinoma (4%, n=4) while rest had NSCLC not specified. Most (54%) were of poor grade and 17% were grade 2. Only 3% had grade 1 tumor while it was not reported in 26% cases. The T stage distribution was T1 (20%, n=21), T2 (35%, n=38), T3 (17%, n=18), T4 (26%, n=28). 66 (62%) patients underwent concurrent CRT while 41 (38%) patients had surgery as a part of their treatment, with 17 (42%) underwent surgery following neoadjuvant therapy while 23 (56%) patients had upfront surgery. Surgery in any form was associated with improved RFS (p=0.013, log-rank) but not OS (p=0.074, log-rank). A higher baseline PLR ratio was associated with inferior OS (p=0.044, log-rank), but there was no significant association between NLR for either RFS or OS.

      This is a retrospective series of advanced NSCLC suggesting benefit in RFS but not in OS with addition of surgery as the third modality in the definitive treatment. A higher baseline PLR was associated with inferior survival, suggesting potential prognostic value but not NLR. Further analysis is underway for a multivariate model.

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