Inflammation-Based Prognostication in Advanced-Stage NSCLC: A Retrospective Cohort Study

Area of Science:

• Oncology
• Hematology
• Inflammation Markers

Background:

• Neutrophil-to-lymphocyte ratio (NLR) is a known prognostic indicator in non-small cell lung cancer (NSCLC).
• The longitudinal performance of NLR and hemoglobin in routine clinical practice for NSCLC remains unclear.
• This study investigates the prognostic value of baseline and 12-month changes in NLR and hemoglobin in an Eastern European NSCLC cohort.

Purpose of the Study:

• To evaluate the prognostic significance of baseline and longitudinal changes in neutrophil-to-lymphocyte ratio (NLR) and hemoglobin levels.
• To assess the association of these hematologic markers with progression-free survival (PFS) and overall survival (OS) in patients with advanced NSCLC.
• To explore the utility of inexpensive hematologic markers in complementing clinical assessment for NSCLC.

Main Methods:

• Retrospective analysis of 180 adult patients with histologically confirmed NSCLC diagnosed between May 2022 and April 2024.
• Data extraction from electronic health records included demographics, tumor characteristics, molecular profiles, laboratory parameters, and treatments.
• Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and Cox proportional hazards models, including a treatment-start anchored sensitivity analysis.

Main Results:

• A high baseline neutrophil-to-lymphocyte ratio (NLR) (≥3) was associated with increased progression risk (HR 1.60, p=0.014) and a trend towards worse OS.
• A 12-month increase in NLR (62.2% of patients) further elevated progression risk (HR 1.52, p=0.026).
• Low hemoglobin (<12 g/dL) showed a non-significant trend towards increased progression risk (HR 1.38, p=0.074). High PD-L1 expression (≥50%) and chemo-immunotherapy correlated with longer PFS.

Conclusions:

• Exploratory findings suggest that baseline and longitudinal NLR are valuable prognostic markers in advanced NSCLC.
• Inexpensive hematologic markers like NLR can potentially complement clinical assessment in routine care for NSCLC.
• Prospective, multi-center validation is warranted to confirm these findings and their clinical utility.