Hematological biomarkers of inflammation such as the neutrophil-to-lymphocytic rate have been reported as predictors of survival in a variety of cancers. The aim of the present study was to investigate the prognostic value of the perioperative platelet-to-lymphocyte ratio in patients with non–small-cell lung cancer (NSCLC) and to elucidate the effects of the perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) on tumor recurrence and survival in patients undergoing surgical resection for NSCLC.
Methods
This retrospective study included data from 1,637 patients who underwent surgical resection for stage I, II, or III NSCLC. Perioperative data and tumor-related variables were included. Univariate and multivariable Cox proportional hazard ratio (HR) models were used to evaluate the association between perioperative platelet-to-lymphocyte ratio and NSAID use on recurrence-free survival (RFS) and overall survival (OS).
Results
Multivariate analysis showed that a preoperative platelet-to-lymphocyte ratio of at least 180 was associated with reduced rates of RFS (HR = 1.22; 95% confidence interval [CI], 1.03–1.45; P = .019) and OS (HR = 1.33; 95% CI, 1.10–1.62; P = .004). Perioperative use of NSAIDs showed no statistically significant changes in RFS and OS rates (P = .72 and P = .44, respectively).
Conclusions
A higher preoperative inflammatory status is associated with decreased rates of RFS and OS in patients with NSCLC undergoing curative surgery. Perioperative use of NSAIDs was not found to be an independent predictor of survival.
MillerK.D., SiegelR., LinC.C.Cancer treatment and survivorship statistics, 2016.CA Cancer J Clin.2016; 66(4): 271–289.
3.
GreenJ.S., TsuiB.C.Impact of anesthesia for cancer surgery: Continuing professional development.Can J Anaesth.2013; 60(12): 1248–1269.
4.
SnyderG.L., GreenbergS.Effect of anaesthetic technique and other perioperative factors on cancer recurrence.Br J Anaesth.2010; 105(2): 106–115.
5.
ChoiJ.E., VillarrealJ., LasalaJ.Perioperative neutrophil: lymphocyte ratio and postoperative NSAID use as predictors of survival after lung cancer surgery: a retrospective study.Cancer Med.2015; 4(6): 825–833.
6.
AsherV., LeeJ., InnamaaA.Preoperative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer.Clin Transl Oncol.2011; 13(7): 499–503.
7.
KosM., HocazadeC., KosF.T.Prognostic role of pretreatment platelet/lymphocyte ratio in patients with non-small cell lung cancer.Wien Klin Wochenschr.2015. Epub ahead of print.
8.
ChenQ., DaiZ., YinD.Negative impact of preoperative platelet-lymphocyte ratio on outcome after hepatic resection for intrahepatic cholangiocarcinoma.Medicine (Baltimore).2015; 94(13): e574.
9.
Krenn-PilkoS., LangsenlehnerU., ThurnerE.M.The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients.Br J Cancer.2014; 110(10): 2524–2530.
10.
NurdenA.T.Platelets, inflammation and tissue regeneration.Thromb Haemost.2011; 105(suppl 1): S13–S33.
CoussensL.M., WerbZ.Inflammation and cancer.Nature.2002; 420(6917): 860–867.
13.
BalkwillF., MantovaniA.Inflammation and cancer: back to Virchow?Lancet.2001; 357(9255): 539–545.
14.
BenishM., BartalI., GoldfarbY.Perioperative use of betablockers and COX-2 inhibitors may improve immune competence and reduce the risk of tumor metastasis.Ann Surg Oncol.2008; 15(7): 2042–2052.
15.
ZhangS., DaL., YangX.Celecoxib potentially inhibits metastasis of lung cancer promoted by surgery in mice, via suppression of the PGE2-modulated β-catenin pathway.Toxicol Lett.2014; 225(2): 201–207.
16.
SinghB., CookK.R., VincentL.Role of COX-2 in tumorospheres derived from a breast cancer cell line.J Surg Res.2011; 168(1): e39–49.
17.
ForgetP., BentinC., MachielsJ.P.Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery.Br J Anaesth.2014; 113(suppl 1): i82–i87.
18.
ZhouX., DuY., HuangZ.Prognostic value of PLR in various cancers: a meta-analysis.PLoS One.2014; 9(6): e101119.
19.
CataJ.P., VillarrealJ., KeertyD.Perioperative beta-blocker use and survival in lung cancer patients.J Clin Anesth.2014; 26(2): 106–117.
20.
UnalD., ErogluC., KurtulN.ABO blood groups are not associated with treatment response and prognosis in patients with local advanced non- small cell lung cancer.Asian Pac J Cancer Prev.2013; 14(6): 3945–3948.
21.
CannonN.A., MeyerJ., IyengarP.Neutrophil-lymphocyte and platelet-lymphocyte ratios as prognostic factors after stereotactic radiation therapy for early-stage non-small-cell lung cancer.J Thorac Oncol.2015; 10(2): 280–285.
22.
ArrietaO., Michel OrtegaR.M., Villanueva-RodriguezG.Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study.BMC Cancer.2010; 10: 50.
23.
MiyazakiT., YamasakiN., TsuchiyaT.Inflammation-based scoring is a useful prognostic predictor of pulmonary resection for elderly patients with clinical stage I non-small-cell lung cancer.Eur J Cardiothorac Surg.2015; 47(4): e140–e145.
24.
PinatoD.J., ShinerR.J., SecklM.J.Prognostic performance of inflammation-based prognostic indices in primary operable non-small cell lung cancer.Br J Cancer.2014; 110(8): 1930–1935.
25.
LazennecG., RichmondA.Chemokines and chemokine receptors: new insights into cancer-related inflammation.Trends Mol Med.2010; 16(3): 133–144.
26.
FridmanW.H., PagesF., Sautes-FridmanC.The immune contexture in human tumours: impact on clinical outcome.Nat Rev Cancer.2012; 12(4): 298–306.
27.
BambaceN.M., HolmesC.E.The platelet contribution to cancer progression.J Thromb Haemost.2011; 9(2): 237–249.
28.
MaoY., SarhanD., StevenA.Inhibition of tumor-derived prostaglandin-e2 blocks the induction of myeloid-derived suppressor cells and recovers natural killer cell activity.Clin Cancer Res.2014; 20(15): 4096–4106.
29.
TangC., LiaoZ., GomezD.Lymphopenia association with gross tumor volume and lung V5 and its effects on non-small cell lung cancer patient outcomes.Int J Radiat Oncol Biol Phys.2014; 89(5): 1084–1091.
30.
CampianJ.L., YeX., BrockM.Treatment-related lymphopenia in patients with stage III non-small-cell lung cancer.Cancer Invest.2013; 31(3): 183–188.
31.
AlifanoM., Mansuet-LupoA., LococoF.Systemic inflammation, nutritional status and tumor immune microenvironment determine outcome of resected non-small cell lung cancer.PLoS One.2014; 9(9): e106914.
32.
WangD., WuM., FengF.Z.Pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios do not predict survival in patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy.Chin Med J (Engl).2013; 126(8): 1464–1468.
33.
KwonH.C., KimS.H., OhS.Y.Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer.Biomarkers.2012; 17(3): 216–222.
34.
RaungkaewmaneeS., TangjitgamolS., ManusirivithayaS.Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer.J Gynecol Oncol.2012; 23(4): 265–273.
35.
AzabB., ShahN., RadbelJ.Pretreatment neutrophil/lymphocyte ratio is superior to platelet/lymphocyte ratio as a predictor of long-term mortality in breast cancer patients.Med Oncol.2013; 30(1): 432.
36.
WhitsonB.A., D'CunhaJ., AndradeR.S.Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity.Ann Thorac Surg.2008; 86(6): 1735–1744.
