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2015 ; 112
(7
): 1157-65
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The neutrophil-lymphocyte ratio and its utilisation for the management of cancer
patients in early clinical trials
#MMPMID25719834
Kumar R
; Geuna E
; Michalarea V
; Guardascione M
; Naumann U
; Lorente D
; Kaye SB
; de Bono JS
Br J Cancer
2015[Mar]; 112
(7
): 1157-65
PMID25719834
show ga
BACKGROUND: Inflammation is critical to the pathogenesis and progression of
cancer, with a high neutrophil-lymphocyte ratio (NLR) associated with poor
prognosis. The utility of studying NLR in early clinical trials is unknown.
METHODS: This retrospective study evaluated 1300 patients treated in phase 1
clinical trials between July 2004 and February 2014 at the Royal Marsden Hospital
(RMH), UK. Data were collected on patient characteristics and baseline laboratory
parameters. RESULTS: The test cohort recruited 300 patients; 53% were female, 35%
ECOG 0 and 64% ECOG 1. RMH score was 0-1 in 66% and 2-3 in 34%. The median NLR
was 3.08 (IQR 2.06-4.49). Median OS for the NLR quartiles was 10.5 months for
quartile-1, 10.3 months for quartile-2, 7.9 months for quartile-3 and 6.5 months
for quartile-4 (P<0.0001). Univariate analysis identified RMH score (HR=0.55,
P<0.0001), ECOG (HR=0.62, P=0.002) and neutrophils (HR=0.65, P=0.003) to be
associated with OS. In multivariate analysis, adjusting for RMH score, ECOG,
neutrophils and tumour type, NLR remained significantly associated with OS
(P=0.002), with no association with therapeutic steroid use. These results were
validated in a further 1000 cancer patients. In the validation cohort, NLR was
able to discriminate for OS (P=0.004), as was the RMH score. This was further
improved on in the RMH score+NLR50 and RMH score+Log10NLR models, with an optimal
NLR cutoff of 3.0. CONCLUSIONS: NLR is a validated independent prognostic factor
for OS in patients treated in phase 1 trials. Combining the NLR with the RMH
score improves the discriminating ability for OS.
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