The relationship between blood biomarkers and prognosis of pathologic stage IA pure-solid non-small cell lung cancer...

For patients with clinical stage IA (cIA) non-small cell lung cancer (NSCLC) who received the standard treatment of lobectomy combined with systematic lymph node dissection, some still might experience postoperative recurrence or metastasis. Previous studies have shown that lung cancer patients whose tumors appear as solid nodules on imaging have a higher recurrence rate compared to those with ground glass nodules. Thus, it would be recommended for postoperatively upstaged patients to receive additional adjuvant therapy. So far, there have not been reliable biomarkers to distinguish the subgroup of NSCLC patients with a higher risk of recurrence within the pathologic stage IA (pIA). Therefore, we aimed to investigate the prognostic role of preoperative blood biomarkers in patients with pIA pure-solid NSCLC undergoing surgery.

We retrospectively reviewed clinical data of pIA NSCLC patients who underwent radical surgery between 2014 and 2016. For subgroup comparisons, we also collected information from NSCLC patients with pathological stage T1N1-2M0 (pT1N1-2M0) during the same period. The optimal cut-off value of biomarkers was determined by receiver operating characteristic (ROC) analysis. The Kaplan-Meier method, univariate and multivariate Cox regression analyses were used to analyze the predictors for disease-free survival (DFS) and overall survival (OS).

A total of 255 NSCLC patients were enrolled in this study, with 205 stage pIA and 50 stage pT1N1-2M0 NSCLC patients. The independent predictors of DFS in pIA NSCLC patients were neutrophil to lymphocyte ratio (NLR) [P=0.005, hazard ratio (HR) =3.869, 95% confidence interval (CI): 1.499-9.986] and serum carcinoembryonic antigen (CEA) (P=0.007, HR =2.506, 95% CI: 1.281-4.901). The independent predictors of OS in pIA NSCLC patients were systemic inflammatory response index (SIRI) (P=0.03, HR =2.501, 95% CI: 1.110-5.636), CEA (P=0.002, HR =3.691, 95% CI: 1.646-8.280) and serum squamous cell carcinoma antigen (SCCA) (P=0.004, HR =4.323, 95% CI: 1.606-11.640). The NSCLC patients with SIRI >0.981 group and CEA >3.78 ng/mL group were similar to those in pN1 group in 3-year OS rates (89.7%, 94.0% vs. 92.9%) and 5-year OS rates (82.4%, 82.0% vs. 78.6%) after surgery.

For patients with pIA pure-solid NSCLC, preoperative biomarkers SIRI, NLR, CEA, and SCCA may serve as predictors for postoperative survival.