Association of neutrophil-lymphocyte ratio with survival in peripheral early-stage non–small-cell lung cancer after stereotactic body radiation therapy.

person Karen Huang Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY info_outline Karen Huang, Sharan Prasad, Sung Jun Ma, Han Yu, Austin Iovoli, Mark Farrugia, Elisabeth Dexter, Todd L. Demmy, Nadia Karen Malik, Anurag K. Singh

Authors person Karen Huang Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY info_outline Karen Huang, Sharan Prasad, Sung Jun Ma, Han Yu, Austin Iovoli, Mark Farrugia, Elisabeth Dexter, Todd L. Demmy, Nadia Karen Malik, Anurag K. Singh Organizations Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, Cornell University, Ithaca, NY, University at Buffalo, Buffalo, NY, Roswell Park Cancer Institute, Buffalo, NY, Roswell Park Comprehensive Cancer Center, Buffalo, NY, Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, Roswell Park Cancer Institute Department of Cancer Prevention and Population Sciences, Buffalo, NY Abstract Disclosures Research Funding No funding received None. Background: Prior studies have demonstrated that neutrophil-lymphocyte ratio (NLR) can predict overall survival in patients undergoing stereotactic body radiation therapy (SBRT) for multiple types of cancer. The role of neutrophil-lymphocyte ratio (NLR) as a predictor for survival in single fraction SBRT-treated non-small cell lung cancer (NSCLC) patients remains unclear. Methods: A single-institution database of peripheral early-stage NSCLC patients treated with SBRT from February 2007 to May 2022 was queried. Consecutive patients with peripheral early-stage NSCLC (T1-2N0M0) and a complete blood count within six months of the start of SBRT treatment were included. Patients treated with SBRT regimens of more than 3 fractions were excluded as these regimens were reserved for patients with centrally located lesions with higher risk of toxicity which could affect survival. Optimal threshold of neutrophil-lymphocyte ratio (NLR) was defined based on maximally selected rank statistics. Cox multivariable analysis (MVA), Kaplan-Meier, and propensity score matching were performed to evaluate outcomes. Results: A total of 286 patients (164 female [57.3%]; median [IQR] age 76 [69-81] years) were included for analysis with median follow up of 19.7 months. The median NLR was 3.06 ([IQR] 2.21-4.33). There were 15 local failures, 27 nodal failures, and 50 distant failures. On Cox multivariate analysis, as a continuous variable, NLR was shown to be an independent predictor of OS (adjusted hazards ratio [aHR] 1.06, 95% CI 1.02-1.10, p = 0.005; Figure 1) and PFS (aHR 1.05, 95% CI 1.01-1.09, p = 0.013; Figure 1). In addition, NLR was associated with DF (aHR 1.11, 95% CI 1.05-1.18, p < 0.001; Figure 1). Maximally selected rank statistics determined 3.28 as the cutoff point of high NLR versus low NLR. These findings were confirmed upon propensity matching. Conclusions: Pretreatment NLR is an independent predictor for survival outcomes of peripheral early-stage NSCLC patients after SBRT. High NLR is associated with worse overall survival, progression-free survival, and distant metastasis. Pretreatment NLR levels should be tracked on trials for early-stage NSCLC patients.