The Association Between Preoperative Neutrophil-to-Lymphocyte Ratio (NLR) And Clinicopathologic Features Of Patients With Lung Cancer

BackgroundBased on the Global Cancer Statistics2008estimates, about12.7million cancer cases and7.6million cancer deaths are estimated to have occurred in2008。Lung cancer is still the leading cause of cancer-related mortality worldwide. Lung cancer accounts for13%(1.6million) of the total cases and18%(1.4million) of the deaths in2008. Recently, neutrophil-to-lymphocyte ratio (NLR), a simple and valid composite marker of systemic inflammatory response, has been associated with many types of cancer. In this study,we want to explore the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and the clinicopathologic features of patients with lung cancer.Patients and MethodsPatients who underwent complete resection for lung cancer from January2008to December2008in Shandong Provincial Hospital were included. Age, sex, smoking history, comorbidity, preoperative lymphocyte counts and neutrophil counts, surgery type and postoperative pathological information were recorded. The postoperative pathological information consisted of tumor size, histology, differentiation,lymphatic metastasis and so on. The data of routine blood test was collected from the last routine blood test before surgery. The peripheral neutrophil-to-lymphocyte ratio (NLR) was calculated from the differential count by dividing the absolute neutrophil count by the absolute lymphocyte count.The statistical analyses were performed using software (SPSS version18.0). In the analyses, p<0.05was considered to be statistically significant.ResultsTotally,234patients were enrolled in the research, with a median age of60(range38to84years). Altogether,170of the234patients were male (72.6%). The patients were divided into groups according to age, sex, smoking history, comorbidity, histology,differentiation and TNM stage. Then, the differences of neutrophil-to-lymphocyte ratio (NLR) among different groups were compared. Male patients, patients with a smoking history and patients with advanced lung cancer had a high neutrophil-to-lymphocyte ratio (NLR). While, female patients had a low neutrophil-to-lymphocyte ratio (NLR), as well as patients without a smoking history and patients with early stage lung cancers. The median of neutrophil-to-lymphocyte ratio (NLR) was2.13(range0.33to7.21). According to the neutrophil-to-lymphocyte ratio (NLR), patients were grouped into High-NLR group (NLR≥2.13) and Low-NLR group (NLR<2.13). It was concluded after statistical analyses that in High-NLR group, the proportion of male patients and patients with a smoking history was higher, and the tumor size was larger than that of patients in Low-NLR group. However, in Low-NLR group, the proportion of female patients and patients without a smoking history was higher, and the tumor size was smaller than that of patients in High-NLR group. The T stage of patients in High-NLR group was more advanced than that of patients in Low-NLR group.ConclusionNeutrophil-to-lymphocyte ratio (NLR) is associated with T stage, tumor size and differentiation in patients with lung cancer. The elevated preoperative NLR predicts advanced T stage, large tumor size and poor differentiation.NLR can be used as a routine screening for lung cancer project in the evaluation of tumor size, guiding treatment.