Lung Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_33_3650 - Can the Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) Predict Survival or Local Control in Patients Treated with Stereotactic Body Radiation Therapy (SBRT) for Non-Small Cell Lung Cancer (NSCLC)? A Systematic Review

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Can the Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) Predict Survival or Local Control in Patients Treated with Stereotactic Body Radiation Therapy (SBRT) for Non-Small Cell Lung Cancer (NSCLC)? A Systematic Review
D. Sit1, R. Thomas2, M. E. Giuliani3, P. Lee4, N. Shaverdian4, C. Walker5, and A. Swaminath6,7; 1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada, 2Schulich School of Medicine & Dentistry, Western University, London, ON, Canada, 3Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada, 4Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 5Department of Oncology, McMaster University, Hamilton, ON, Canada, 6McMaster University, Hamilton, ON, Canada, 7Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada

Purpose/Objective(s): Markers of systemic inflammation are increasingly being recognized as prognostic indicators following lung cancer therapy. Two of these markers, the neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios, are most commonly reported, yet their prognostic significance in the setting of stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC) is unclear. Therefore, we conducted a systematic review of NLR and PLR as prognostic factors for overall survival (OS) of patients with stage 1 NSCLC following SBRT with curative intent.

Materials/Methods: Following PRISMA guidelines, the EMBASE, Cochrane library, MEDLINE, and Pubmed databases were searched from January 1996 until September 2017 for primary research studies and systematic literature reviews that reported both pre-treatment NLR and PLR of patients with stage 1 NSCLC and OS of patients following SBRT. Screening, data extraction, and risk of bias assessment were performed by two independent reviewers.

Results: An electronic database search identified 292 articles that met our search criteria of which five (three published full-text and two conference abstracts) were determined to be eligible for inclusion. Studies were all retrospective chart or database reviews conducted in North America, and were published between 2015 and 2017. The dose fractionation schemes varied between studies, ranging predominantly from 30 Gy to 60 Gy in 3 to 5 fractions. A formal meta-analysis was not feasible due to the heterogeneity of published studies. Overall, there were variations as to whether NLR and PLR variables were analyzed as a continuous versus dichotomous prognostic factor. When dichotomized, cut-offs for a high NLR ranged from 2.18 to 3.16 while cut-offs for a high PLR ranged from 146 to 187.27. Four studies analyzed NLR as a dichotomous factor and all found a statistically significant association of high NLR with worse OS. Similarly, all three studies that examined PLR as a dichotomous prognostic factor found a statistically significant association between high PLR and worse OS. As a continuous variable, two of three studies found NLR to be a significant prognostic factor for OS while only two of four studies found PLR to be a significant prognostic factor for OS.

Conclusion: NLR and PLR appear to be relevant prognostic factors for OS following lung SBRT in stage I NSCLC, particularly when NLR and PLR were dichotomized as high and low values. A minimum cut-off value of above 3.00 for NLR and 155 for PLR may be appropriate, but requires further prospective validation. NLR and PLR are readily accessible and inexpensive tests that can be performed in the clinic to aid in clinical decision-making on the appropriateness of SBRT for stage 1 NSCLC.

Author Disclosure: D. Sit: None. R. Thomas: None. M.E. Giuliani: Honoraria; Elekta Inc. Travel Expenses; Elekta Inc. Chair, Education Committee; Canadian Association of Radiation Oncology. P. Lee: Honoraria; Viewray. Commitee Co-Chair; Committee Co-Chair. N. Shaverdian: None. A. Swaminath: None.

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TU_33_3650 - Can the Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) Predict Survival or Local Control in Patients Treated with Stereotactic Body Radiation Therapy (SBRT) for Non-Small Cell Lung Cancer (NSCLC)? A Systematic Review



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