The Role of Neutrophil-to-Lymphocyte Ratio in Advanced EGFR-Mutant NSCLC Patients Treated with First-Line Osimertinib

Abstract

Purpose

Although serum neutrophil-to-lymphocyte ratio (NLR) is correlated with the outcome of various cancer types, its role in treatment-naïve, advanced, epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients treated with osimertinib remains uncertain. We have the intention to use this biomarker to evaluate the outcomes in NSCLC.

Patients and Methods

Advanced EGFR-mutant NSCLC patients receiving osimertinib as the first-line treatment were included. We evaluated the prognostic role of baseline NLR and explored its association with patients’ characteristics. A high NLR was defined as pretreatment serum NLR ≥ 5.

Results

A total of 112 eligible patients were included. The objective response rate was 83.7%. The median progression-free survival (PFS) and overall survival (OS) were 20.5 months (95% CI 14.5–26.5) and 47.3 months (95% CI 36.7–58.2), respectively. A high NLR predicted an inferior PFS (HR 1.90 [95% CI 1.02–3.51], P = 0.042) and OS (HR 3.85 [95% CI 1.39–10.66], P = 0.009). Patients with stage IVB disease were more likely to have a high baseline NLR than those with stage IIIB-IVA (33.9% vs 15.1%, P = 0.029). Other patients’ characteristics did not correlate with the baseline NLR significantly. Patients with a high NLR had significantly more metastatic organs than those with a low NLR (2.5 ± 1.3 vs 1.8 ± 0.9, P = 0.012), particularly brain, liver, and bone metastasis. There was no significant association between NLR and intrathoracic metastasis.

Conclusion

Baseline serum NLR could act as an important prognostic marker for EGFR-mutant NSCLC patients receiving first-line osimertinib. A high NLR was associated with higher metastatic burden, more extrathoracic metastases, and therefore, a worse outcome.

Keywords:

• non-small cell lung cancer
• epidermal growth factor receptor
• osimertinib
• neutrophil-to-lymphocyte ratio
• treatment-naïve

Acknowledgments

Kuan-Chih Chen and Yen-Hsiang Huang contributed equally to the work as co-first authors. We would like to thank the Cancer Prevention and Control Center of Taichung Veterans General Hospital for assisting with the data collection and management and we also thank the NRPB Pharmacogenomics Lab and the NCFPB Integrated Core Facility for Functional Genomics for their technical support.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There is no funding to report.