The relationship between inflammation markers, positron emission tomography/ /computed tomography parameters and disease prognosis in advanced non-small-cell lung cancer patients
, 2, 3, 4, 4, 2, 2, 2, 5, 2
Abstract
Introduction. Inflammation is known to be related to the development, spread, prognosis, and treatment response in cancer patients. Our study aimed to evaluate the correlation between inflammation indices and positron emission tomography-computed tomography (PET/CT) parameters and investigate their relationship with progression-free survival (PFS) and overall survival (OS) in patients diagnosed with stage-IV non-small cell lung cancer (NSCLC).
Material and methods. Demographic, clinicopathological, laboratory, and PET/CT data of 179 patients diagnosed with stage-IV NSCLC who presented to the Oncology Department of Dicle University, Faculty of Medicine between 2010–2020 were retrieved from patient files and the hospital database system.
Results. The median age at diagnosis was 64 (27–87) years. All patients included in the study had NSCLC: 72.6% had adenocarcinoma, 21.2% had squamous cell carcinoma, and 6.1% had other histological types. Of the 78 patients who were subjected to molecular analysis, 26 (33.3%) were EGFR-mutation positive. During the 10-month median follow-up, median first-line PFS was 6 months (95% CI 5.00–6.99), and median OS was 10 months (95% CI 7.8–12.1). The multivariate analysis performed for first-line PFS determined hemoglobin (HR = 1.01; 95% CI 1.003–1.02; p = 0.005) and PET total lesion glycolysis (TLG) (HR = 1.002; 95% CI 1.001–1.003; p = 0.003) values as independent prognostic factors. The multivariate analysis for OS determined positive EGFR mutation status (HR = 0.385; 95% CI 0.213–0.696; p = 0,014) and performance status (HR = 1.88; 95% CI 1.092–3.238; p = 0,008) as independent prognostic factors.
Conclusions. Our study determined the hemoglobin level and PET TLG from PET/CT parameters to be independent prognostic factors for PFS, and performance status and EGFR mutation positivity to be independent prognostic factors for OS.
Keywords: inflammationnon-small-cell lung cancerPET/CT
References
- Wei S, Tian J, Song X, et al. Causes of death and competing risk analysis of the associated factors for non-small cell lung cancer using the Surveillance, Epidemiology, and End Results database. J Cancer Res Clin Oncol. 2018; 144(1): 145–155.
- Remon J, Ahn MJ, Girard N, et al. Advanced-Stage Non-Small Cell Lung Cancer: Advances in Thoracic Oncology 2018. J Thorac Oncol. 2019; 14(7): 1134–1155.
- Paesmans M, Berghmans T, Dusart M, et al. European Lung Cancer Working Party, and on behalf of the IASLC Lung Cancer Staging Project. Primary tumor standardized uptake value measured on fluorodeoxyglucose positron emission tomography is of prognostic value for survival in non-small cell lung cancer: update of a systematic review and meta-analysis by the European Lung Cancer Working Party for the International Association for the Study of Lung Cancer Staging Project. J Thorac Oncol. 2010; 5(5): 612–619.
- Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011; 144(5): 646–674.
- McSorley ST, Khor BY, Tsang K, et al. The relationship between F-FDG-PETCT-derived markers of tumour metabolism and systemic inflammation in patients with recurrent disease following surgery for colorectal cancer. Colorectal Dis. 2018; 20(5): 407–415.
- Guner A, Kim HI. Biomarkers for Evaluating the Inflammation Status in Patients with Cancer. J Gastric Cancer. 2019; 19(3): 254–277.
- Cuyún Carter G, Barrett AM, Kaye JA, et al. A comprehensive review of nongenetic prognostic and predictive factors influencing the heterogeneity of outcomes in advanced non-small-cell lung cancer. Cancer Manag Res. 2014; 6: 437–449.
- Pawelczyk K, Piotrowska A, Ciesielska U, et al. Role of PD-L1 Expression in Non-Small Cell Lung Cancer and Their Prognostic Significance according to Clinicopathological Factors and Diagnostic Markers. Int J Mol Sci. 2019; 20(4).
- Sarhill N, Mahmoud FA, Christie R, et al. Assessment of nutritional status and fluid deficits in advanced cancer. Am J Hosp Palliat Care. 2003; 20(6): 465–473.
- Simmons CP, Koinis F, Fallon MT, et al. Prognosis in advanced lung cancer--A prospective study examining key clinicopathological factors. Lung Cancer. 2015; 88(3): 304–309.
- Lobefaro R, Viscardi G, Di Liello R, et al. Immunotherapy in advanced Non-Small Cell Lung Cancer patients with poor performance status: The role of clinical-pathological variables and inflammatory biomarkers. Lung Cancer. 2021; 152: 165–173.
- Pao W, Miller V, Zakowski M, et al. EGF receptor gene mutations are common in lung cancers from "never smokers" and are associated with sensitivity of tumors to gefitinib and erlotinib. Proc Natl Acad Sci U S A. 2004; 101(36): 13306–13311.
- Paz-Ares L, Soulières D, Melezínek I, et al. Clinical outcomes in non-small-cell lung cancer patients with EGFR mutations: pooled analysis. J Cell Mol Med. 2010; 14(1-2): 51–69.
- Zhang YH, Lu Y, Lu H, et al. Pre-treatment hemoglobin levels are an independent prognostic factor in patients with non-small cell lung cancer. Mol Clin Oncol. 2018; 9(1): 44–49.
- Kos FT, Hocazade C, Kos M, et al. Assessment of Prognostic Value of "Neutrophil to Lymphocyte Ratio" and "Prognostic Nutritional Index" as a Sytemic Inflammatory Marker in Non-small Cell Lung Cancer. Asian Pac J Cancer Prev. 2015; 16(9): 3997–4002.
- Zhao QT, Yuan Z, Zhang H, et al. Prognostic role of platelet to lymphocyte ratio in non-small cell lung cancers: A meta-analysis including 3,720 patients. Int J Cancer. 2016; 139(1): 164–170.
- Cupp MA, Cariolou M, Tzoulaki I, et al. Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies. BMC Med. 2020; 18(1): 360.
- Qiang G, Liang C, Xiao F, et al. Prognostic significance of platelet-to-lymphocyte ratio in non-small-cell lung cancer: a meta-analysis. Onco Targets Ther. 2016; 9: 869–876.
- Yin Y, Wang J, Wang X, et al. Prognostic value of the neutrophil to lymphocyte ratio in lung cancer: A meta-analysis. Clinics (Sao Paulo). 2015; 70(7): 524–530.
- Chen Y, Wang W, Zhang X, et al. Prognostic importance of the nutritional status and systemic inflammatory response in non-small cell lung cancer. J BUON. 2013; 18(3): 728–732.
- Liu ZL, Zeng TT, Zhou XJ, et al. Neutrophil-lymphocyte ratio as a prognostic marker for chemotherapy in advanced lung cancer. Int J Biol Markers. 2016; 31(4): e395–e401.
- Tan Z, Xue H, Sun Y, et al. The Role of Tumor Inflammatory Microenvironment in Lung Cancer. Front Pharmacol. 2021; 12: 688625.
- McSorley ST, Khor BY, Tsang K, et al. The relationship between F-FDG-PETCT-derived markers of tumour metabolism and systemic inflammation in patients with recurrent disease following surgery for colorectal cancer. Colorectal Dis. 2018; 20(5): 407–415.
- Polverari G, Ceci F, Bertaglia V, et al. F-FDG Pet Parameters and Radiomics Features Analysis in Advanced Nsclc Treated with Immunotherapy as Predictors of Therapy Response and Survival. Cancers (Basel). 2020; 12(5).
- Sharma A, Mohan A, Bhalla AS, et al. Role of Various Metabolic Parameters Derived From Baseline 18F-FDG PET/CT as Prognostic Markers in Non-Small Cell Lung Cancer Patients Undergoing Platinum-Based Chemotherapy. Clin Nucl Med. 2018; 43(1): e8–ee17.
- Sahiner I, Vural GU. Positron emission tomography/computerized tomography in lung cancer. Quant Imaging Med Surg. 2014; 4(3): 195–206.
- Chen HHW, Lee BF, Su WC, et al. Prognostic value of whole-body total lesion glycolysis at pretreatment FDG PET/CT in non-small cell lung cancer. Radiology. 2012; 264(2): 559–566.
- van Loon J, Offermann C, Ollers M, et al. Early CT and FDG-metabolic tumour volume changes show a significant correlation with survival in stage I-III small cell lung cancer: a hypothesis generating study. Radiother Oncol. 2011; 99(2): 172–175.
- Berghmans T, Dusart M, Paesmans M, et al. European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. Primary tumor standardized uptake value (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. J Thorac Oncol. 2008; 3(1): 6–12.
- Mirili C, Guney IB, Paydas S, et al. Prognostic significance of neutrophil/lymphocyte ratio (NLR) and correlation with PET-CT metabolic parameters in small cell lung cancer (SCLC). Int J Clin Oncol. 2019; 24(2): 168–178.
- Komek H, Altindag S, Can C. Association of PET Scan Parameters of Pulmonary Masses and Reticuloendothelial System with Hematologic Parameters. J Nucl Med Radiat Ther. 2017; 08(02).