Systemic inflammation, TNM staging and survival in patients with lung cancer

Abstract Background It is recognised that systemic inflammation plays an important role in the development and progression of lung cancer. Several affordable biomarkers could be used to evaluate systemic inflammation: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and erythrocyte sedimentation rate (ESR). These biomarkers may be linked with survival in lung cancer. Aim To assess the relation between systemic inflammation evaluated by NLR, PLR and ESR, tumour nodes metastasis (TNM) staging and negative outcome in lung cancer. Materials and methods Patients with lung cancer were classified (7th TNM lung cancer staging) into two groups: Group A (resectable stages) and Group B (nonresectable stages). Each group was divided into two subsets: survivors (As, Bs) and deceased (Ad, Bd) patients. Complete blood count (CBC) and ESR were determined. NLR and PLR were calculated. NLR, PLR and ESR values were compared between the two groups and their subsets. Results 102 consecutive patients completed the protocol. In Group A (31 patients): NLR: 2.74 (0.87–12.94), PLR: 33.95 (21.61–416.66), ESR: 35 mm/h (6–135). Subgroup As: NLR: 2.36 (0.87–8.36), PLR: 138.82 (21.61–416.66), ESR: 15 mm/h (6–110). Subgroup Ad: NLR: 2.77 (1.25–12.94), PLR: 132.57 (41.11–371.17), ESR: 62 mm/h (11–135). In Group B (71 patients): NLR: 3.51(0.76–25.60), PLR: 170.37 (3.38–651.25), ESR:40 mm/h (3–120). Subgroup Bs: NLR: 1.40 (1.32–1.73), PLR: 112.89 (91.14–140.54), ESR: 31 mm/h (9–90). Subgroup Bd: NLR: 3.59 (0.70–25.60), PLR: 183.50 (3.38–651.25), ESR: 44 mm/h (3–120). NLR and PLR values were significantly higher (p: 0.04; p: 0.05) in Group B versus Group A. No significant difference was noted for ESR values between the two groups. In patients with nonresectable stages who were deceased (subgroup Bd), NLR and PLR values were significantly higher (p: 0.01; p: 0.03) versus survivals. In patients with resectable stages who were deceased (subgroup Ad), only the ESR value was significantly higher versus survivals. Conclusions Systemic inflammation assessed by affordable biomarkers as NLR and PLR is more prominent in advanced, nonresectable lung cancer. It may be a contributor, along with TNM staging, to the poor outcome of patients with nonresectable lung cancer. Clinical implication NLR and PLR may represent a valuable additional tool in the clinical management of patients with nonresectable lung cancer.