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E.R. Siegel
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P1.07 - Poster Session/ Small Cell Lung Cancer (ID 221)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.07-015 - The Prognostic Value of the Neutrophil Lymphocyte Ratio in Patients with Small Cell Lung Cancer (ID 964)
09:30 - 09:30 | Author(s): E.R. Siegel
- Abstract
Background:
A high neutrophil to lymphocyte ratio (NLR) is reported to be a poor prognostic indicator in several malignancies and is associated with inferior survival. There is limited data exploring the prognostic role of NLR in small cell lung cancer (SCLC). The aim of the study was to evaluate the prognostic role of the NLR at the time of diagnosis in patients with SCLC.
Methods:
We retrospectively analyzed data from July 2010 to June 2013 of patients diagnosed with SCLC at a single tertiary care center. NLR ≥4 at the time of diagnosis was correlated with other prognostic variables to estimate its effect on the overall survival (OS).
Results:
There were a total of 80 eligible patients, including 33 males and 47 females. At the time of diagnosis, NLR ≥4 was seen in 36 (45%) patients. Overall, median absolute neutrophil count was 6.15 K/uL and absolute lymphocyte count was 1.6 K/uL. Both groups were comparable for age, gender, body mass index and ECOG functional score. We found 31/36 (86.11%) patients with NLR ≥4 who had extensive stage disease. In contrast, only 24/44 (54.55%) patients with NLR <4 had extensive stage disease (P= 0.0024). All 25/25 (100%) patients with limited stage disease received chemoradiation, while 44/55 (80%) of patients with extensive stage disease received chemotherapy. The median overall survival was 8.7 versus 11.2 months for patients with NLR ≥4 versus NLR <4 (log-rank P=0.014) (Figure 1). Multivariate Cox regression detected a strong interaction (P=0.0024) between NLR and the combined status of chemotherapy and stage. In the limited stage group, NLR ≥4 patients had slightly worse OS (HR=2.13, 95% CI: 0.66-6.86; P=0.20), whereas in the extensive stage group which received chemotherapy, NLR ≥4 patients had slightly better OS (HR=0.80, 95% CI: 0.42-1.53; P=0.50). In the extensive-stage group which did not receive chemotherapy, NLR ≥4 patients had significantly worse OS (HR=12.7, 95% CI: 2.94-55.2; P=0.0007).
Conclusion:
Similar to the other studies in solid tumors, we found a prognostic value of NLR in all patients with SCLC. However, NLR was prognostically significant only among patients with extensive-stage disease who did not receive chemotherapy. Among patients of both stage groups who received chemotherapy, NLR had little prognostic value. NLR ≥4 appears to be more prevalent in patients with extensive stage disease probably reflecting an impaired immune system. Further research exploring the role of immune system and associated immune surrogate markers in SCLC is needed. Figure 1
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P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.04-077 - Diagnosis and Prognosis of Non-Small Cell Lung Cancer Based on Metabolic Profiles of Mediastinal Lymph Node Aspirates (ID 3050)
09:30 - 09:30 | Author(s): E.R. Siegel
- Abstract
Background:
Non-small cell lung cancer (NSCLC) has a high mortality. TNM staging has prognostic implications, but there is a paucity of biomarkers to predict prognosis. The aim of this study was to evaluate the metabolomic profiles of mediastinal and hilar lymph nodes of NSCLC patients and to determine the prognostic implications of different metabolites.
Methods:
Endobronchial ultrasound-guided fine needle aspirates of hilar and mediastinal nodes from patients with NSCLC were collected from January 2011 to February 2013. Metabolomic profiles were generated using liquid chromatography mass spectrometry. Electronic medical records were reviewed for histologic diagnoses and survival status. T-testing was used to compare metabolite differences between groups. Metabolites dichotomized at their median values were assessed for prognostic potential via Cox regressions. P<0.05 was regarded as statistically significant.
Results:
A total of 79 lymph node aspirates were collected. 50 were positive for NSCLC, 13 were negative for NSCLC in patients with biopsy-proven NSCLC at the primary site, and 16 were from patients with non-malignant lung disease. The histologic subtypes of patients with NSCLC were 38 (60.3%) adenocarcinoma (AD) and 25 (39.7%) squamous cell carcinoma (SCC). TNM staging for the patients with NSCLC was as follows: 8 (12.7%) stage I, 10 (15.9%) stage II, 23 (36.5%) III, and 22 (34.9%) IV. Concentrations of alanine, alpha-ketoglutarate, glutathione (reduced and oxidized states), homocysteine, malate, melatonin, malonyl-carnitine, S-adenosyl homocysteine, and S-adenosylmethionine were statistically significantly higher in NSCLC patients than in patients with benign disease. In contrast, citruline, cysteine, glutamine, isoleucine, L-carnitine, leucine, ornithine, tryptophan, and valine were lower in the NSCLC group than in the benign group. Metabolite concentrations were different for different cancer sub-types; SCC patients had a 4.92-fold higher concentration of succinate than AD (p<0.0001), whereas AD had a 1.52-fold higher concentration of homocysteine than SCC (p=0.041). Elevated concentrations of the following metabolites were associated with shorter overall survival: melatonin (HR=2.24, 95% CI: 1.27-3.97; p=0.0057) Figure 1, malate (HR=1.91, 95% CI: 1.08-3.35; p=0.025), cystathionine (HR=1.84, 95% CI: 1.03-3.28; p=0.039), and glutamate (HR=1.77, 95% CI: 1.01-3.09; p=0.045). Figure 1
Conclusion:
Metabolomic data demonstrate differences between different NSCLC subtypes. In addition, metabolomic data may have prognostic potential that is independent from that associated with TNM stage. Metabolites associated with worsened prognosis offer an avenue for research; they may allow us to identify specific pathways that correlate with prognosis.
