Background: Lung cancer (LC) is a complex-to-treat disease and remains the leading cause of cancer-related mortality.Methods: Our aim was to investigate the prognostic role of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) in patients with LC. In this retrospective study, examining the period between 1 June 2020 and 31 May 2024, we recorded consecutive patients who presented to the Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece, and received a first diagnosis of LC. The primary outcome was mortality risk analysis based on NLR, PLR, and MLR at diagnosis. Secondary outcomes included associations of tumor, node, metastasis (TNM) staging, and smoking with NLR, PLR, and MLR at diagnosis.Results: We identified 353 patients with a first diagnosis of LC. The mean age ± SD at the time of diagnosis was 68.1 ± 9.1 years. Most patients were male (77.9%, n = 275) and current or ex-smokers (58.1%, n = 205, and 39.1%, n = 138, respectively). Histological diagnosis was non-small-cell lung cancer (NSCLC), small-cell lung cancer (SCLC), and not otherwise specified (NOS) in 67.1% (n = 237), 29.8% (n = 105), and 3.1% (n = 11) of patients, respectively. Adenocarcinoma NSCLC was more common (40.2%, n = 142) compared to squamous NSCLC (25.5%, n = 90). In 12.9% of patients, we identified EGFR, KRAS, ALK, or BRAF molecular driver mutations, while PD-L1 expression was positive in 20.7% of patients. The majority of enrolled patients presented with advanced stage IV LC at diagnosis (63.2%, n = 223). Kaplan–Meier curves showed that patients with higher than the median NLR and PLR at diagnosis were associated with significantly higher mortality risk compared to those with lower than the median [HR: 0.58, (95% CI: 0.42 to 0.81)p= 0.0009 and HR: 0.71, (95% CI: 0.53 to 0.95)p= 0.02, respectively], while no differences in mortality risk were observed between patients with higher versus lower than the median MLR [HR: 0.84, (95% CI: 0.63 to 1.12)p= 0.22]. With regard to secondary outcomes, no associations between higher versus lower than the median NLR, PLR, or MLR values and TNM staging [4.0 (95% CI: 4.0–4.0) vs. 4.0 (95% CI: 4.0–4.0),p= 0.95, 4.0 (95% CI: 4.0–4.0) vs. 4.0 (95% CI: 4.0–4.0),p= 0.09, 4.0 (95% CI: 4.0–4.0) vs. 4.0 (95% CI: 4.0–4.0),p= 0.4, respectively], as well as smoking status [70 (95% CI: 60–80) vs. 80 (95% CI: 60–80),p= 0.10, 70 (95% CI: 60–80) vs. 80 (95% CI: 60–80),p= 0.46, 80 (95% CI: 60–80) vs. 70 (95% CI: 60–80),p= 0.96, respectively] were reported.Conclusions: NLR and PLR could serve as reliable and clinician-friendly prognosticators of clinical outcomes in patients with LC. Further validation cohorts are sorely needed to prove this notion.
背景：肺癌是一种治疗复杂的疾病，且仍是癌症相关死亡的主要原因。 方法：本研究旨在探讨中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及单核细胞与淋巴细胞比值（MLR）对肺癌患者的预后价值。本回顾性研究纳入2020年6月1日至2024年5月31日期间，于希腊帕特拉斯大学医院呼吸内科连续就诊且首次确诊肺癌的患者。主要结局是基于诊断时NLR、PLR和MLR的死亡风险分析；次要结局包括诊断时肿瘤-淋巴结-转移（TNM）分期、吸烟状况与NLR、PLR及MLR的关联性。 结果：共纳入353例首次确诊肺癌患者。诊断时平均年龄为68.1±9.1岁，男性占77.9%（n=275），当前吸烟者与既往吸烟者分别占58.1%（n=205）和39.1%（n=138）。组织学诊断为非小细胞肺癌（NSCLC）、小细胞肺癌（SCLC）及未明确分型（NOS）者分别占67.1%（n=237）、29.8%（n=105）和3.1%（n=11）；其中腺癌型NSCLC（40.2%，n=142）较鳞状细胞癌型NSCLC（25.5%，n=90）更常见。12.9%的患者检出EGFR、KRAS、ALK或BRAF驱动基因突变，20.7%的患者PD-L1表达阳性。多数患者（63.2%，n=223）在诊断时已处于晚期（IV期）。Kaplan-Meier曲线显示，诊断时NLR与PLR高于中位值的患者，其死亡风险显著高于低于中位值者[风险比（HR）：0.58（95%置信区间：0.42-0.81），p=0.0009；HR：0.71（95%置信区间：0.53-0.95），p=0.02]；而MLR高于与低于中位值患者的死亡风险无显著差异[HR：0.84（95%置信区间：0.63-1.12），p=0.22]。次要结局分析显示，NLR、PLR及MLR高于或低于中位值与TNM分期[分别为4.0（95%置信区间：4.0-4.0）对比4.0（95%置信区间：4.0-4.0），p=0.95；4.0（95%置信区间：4.0-4.0）对比4.0（95%置信区间：4.0-4.0），p=0.09；4.0（95%置信区间：4.0-4.0）对比4.0（95%置信区间：4.0-4.0），p=0.4]及吸烟状况[分别为70（95%置信区间：60-80）对比80（95%置信区间：60-80），p=0.10；70（95%置信区间：60-80）对比80（95%置信区间：60-80），p=0.46；80（95%置信区间：60-80）对比70（95%置信区间：60-80），p=0.96]均无显著关联。 结论：NLR与PLR可作为肺癌患者临床结局可靠且便于临床应用的预后指标，但此结论尚需更多验证队列研究加以证实。
肿瘤(癌症)患者之家