Total lymphocyte count, neutrophil–lymphocyte ratio, and platelet–lymphocyte ratio as prognostic factors in advanced non–small cell lung cancer with chemoradiotherapy

Figures & data

Table 1 Patient characteristics

		Pretreatment lymphocyte count
		Value or no. of patients (%)
Characteristic	All patients	TLC <2.4×10^3/μL	TLC ≥2.4×10^3/μL	P-value
	(n=267)	(n=132)	(n=135)
Demographics
Gender
Male	146	74	72	0.654
Female	121	58	63
Age
Median (IQR), years	62(58–71)	63(59–70)	62(60–71)	0.851
KPS score
60–80	234	113	121	0.283
≥80	33	19	14
Smoking status
Current	92	43	49	0.088
Former	151	72	79
Never	24	17	7
Treatment
Radiation technique
3D-CRT	101	49	52	0.814
IMRT	166	83	83
Chemotherapy
No induction chemo	157	77	80	0.879
Induction chemo	110	55	55
No concurrent chemo	70	36	34	0.698
Concurrent chemo	197	96	101
T status
T1	31	15	16	0.494
T2	72	34	38
T3	70	37	33
T4	88	45	43
Tx	9	4	5
N status
N0	50	23	27	0.905
N1	38	19	19
N2	100	52	48
N3	79	38	41
Disease stage
IIIA	58	27	31	0.641
IIIB	209	105	104
Pretreatment laboratory findings
Hb, median (IQR), g/dL	12.9 (12.0–14.4)	12.9 (12.1–14.4)	12.9 (12.0–14.3)	0.047
WBC, median
(IQR), ×10^3/μL	7.6 (6.3–8.9)	6.8 (5.5–8.3)	8.4 (7.5–9.6)	<0.001
Neutrophils, median
(IQR), ×10^3/μL	4.8 (3.7–5.9)	4.4 (3.4–5.9)	5.1 (4.2–6.1)	0.063
Platelets, median
(IQR), ×10^3/μL	249 (201–316)	245 (197–304)	262 (217–334)	0.189

Abbreviations: 3D-CRT, 3-dimensional conformal radiation therapy; Hb, hemoglobin; IMRT, intensity-modulated radiation therapy; IQR, interquartile range; KPS, Karnofsky Performance Status; TLC, total lymphocyte count; WBC, white blood cells.

Table 2 Univariate analysis of factors potentially associated with overall survival

Characteristics	HR	95% CI	P-value
Age ≥65 years	1.32	0.91–2.46	0.085
Male	0.95	0.74–2.60	0.228
KPS score ≥70	2.32	1.51–4.12	0.009
TNM stage IIIB	1.24	0.87–1.94	0.013
Current smoker	0.84	0.51–1.85	0.182
Receipt of induction chemotherapy	0.73	0.32–1.54	0.797
Receipt of concurrent chemotherapy	0.88	0.45–1.84	0.791
Pretreatment TLC ≥2.4×10^3/μL	0.46	0.39–0.91	0.035
Pretreatment NLR ≥3.4	1.87	1.19–2.63	0.010
Pretreatment PLR ≥136.1	1.78	1.16–2.56	0.025

Abbreviations: HR, hazard ratio; KPS, Karnofsky Performance Status; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; TLC, total lymphocyte count.

Figure 1 Kaplan–Meier plots of overall survival among patients who received chemoradiotherapy for advanced NSCLC stratified by baseline TLC.

Abbreviations: NSCLC, non–small cell lung cancer; TLC, total lymphocyte count.

Figure 2 Kaplan–Meier plots of overall survival among patients who received chemoradiotherapy for advanced NSCLC stratified by baseline NLR.

Abbreviations: NSCLC, non–small cell lung cancer; NLR, neutrophil-to-lymphocyte ratio.

Figure 3 Kaplan–Meier plots of overall survival among patients who received chemoradiotherapy for advanced NSCLC stratified by baseline PLR.

Abbreviations: NSCLC, non–small cell lung cancer; PLR, platelet-to-lymphocyte ratio.

Table 3 Multivariate analysis of factors potentially associated with overall survival

	Model 1 (TLC included)			Model 2 (NLR included)			Model 3 (PLR included)
	HR	95% CI	P-value	HR	95% CI	P-value	HR	95% CI	P-value
Characteristics
Age ≥65 years	1.51	0.88–2.41	0.185	1.43	0.87–2.35	0.176	1.43	0.89–2.35	0.175
KPS score ≥70	1.68	1.04–3.63	0.041	1.53	1.13–3.24	0.032	1.52	1.1–3.23	0.033
TNM stage IIIB	1.32	0.44–2.43	0.162	1.84	0.71–2.82	0.148	1.82	0.74–2.85	0.143
Pretreatment TLC ≥2.4×10^3/μL	0.49	0.33–0.95	0.041
Pretreatment NLR ≥3.4				1.66	1.05–2.79	0.041
Pretreatment PLR ≥136.1							1.67	1.09–2.78	0.038

Abbreviations: HR, hazard ratio; KPS, Karnofsky Performance Status; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; TLC, total lymphocyte count.