Pretreatment neutrophil-to-lymphocyte ratio is a predictive biomarker for EGFR TKI-treated patients with advanced EGFR-mutant Non-small cell lung cancer

BACKGROUND: Neutrophil-lymphocyte ratio (NLR) has been reported as a prognostic biomarker in various cancers, but its prognostic value for advanced epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) treated with EGFR tyrosine kinase inhibitors (TKIs) remains unclear. To address this issue, we performed a retrospective study to investigate the clinical value of NLR in these patients. METHODS: All data were collected from medical records. Sixty-five cases with stage IIIB-IVB EGFR-mutant NSCLC treated with EGFR-TKIs were enrolled. The pretreatment NLR was analyzed for associations with disease control rate (DCR) and progression-free survival (PFS). The primary outcomes of interest were DCR and PFS. All the data were analyzed using SPSS 23.0. The PFS curves were plotted by Kaplan-Meier analysis and log-rank test. Univariate and multivariate Cox regression analyses were used to determine the factors affecting PFS. RESULTS: The results indicated that, compared with those with lower NLR (<2.57), the patients with a higher NLR (≥2.57) showed a significantly shorter PFS (8.8 vs. 12.2 months, P<0.01), and decreased DCR by the end of 8, 10 months after TKIs treatment (62.5% vs. 93.3%, P=0.014; 38.5% vs. 77.8%, P=0.037). COX multivariate analysis showed that NLR was an independent prognostic factor for PFS (P<0.001). CONCLUSIONS: Elevated NLR is significantly associated with lower DCR, shorter PFS, and might act as a meaningful biomarker for predicting the efficacy of TKIs treatment and the prognosis of advanced EGFR-mutant NSCLC. High-quality prospective clinical trials with longer follow-up are needed to further confirm the results.