Comparison of inflammatory indices in patients with metastatic non-small cell lung cancer

Urakçı, Zuhat; Oruc, Zeynep; Kömek, Halil; Ebinç, Senar; Pirinççi, Esra; Kalkan, Ziya; Taşdemir, Bekir; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Işıkdoğan, Abdurrahman

doi:10.1590/1806-9282.20240411

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Original Article • Rev. Assoc. Med. Bras. 71 (4) • 2025 • https://doi.org/10.1590/1806-9282.20240411 linkcopy

Comparison of inflammatory indices in patients with metastatic non-small cell lung cancer

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE: The aim of this study was to compare the prognostic value of inflammatory indices, including the prognostic nutritional index, advanced lung cancer inflammation index, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, Glasgow Prognostic Score, and C-reactive protein/albumin ratio, in patients with metastatic non-small cell lung cancer and to determine whether any of the indices are correlated.

METHODS: The demographic, clinicopathological, and laboratory data of 179 patients with metastatic non-small cell lung cancer who presented to our medical oncology clinic between 2014 and 2021 were retrospectively obtained from the hospital database system.

RESULTS: Among the inflammatory indices, C-reactive protein/albumin ratio (p=0.002), advanced lung cancer inflammation index (p=0.04), and neutrophil/lymphocyte ratio (p=0.008) were associated with overall survival. Multivariate overall survival analysis showed that Eastern Cooperative Oncology Group Performance Status score (HR 1.37; 95%CI 1.06–1.77; p=0.016) and C-reactive protein/albumin ratio (HR 1.13; 95%CI 1.03–1.24; p=0.01) were independent prognostic factors associated with overall survival. Patients with a high and low C-reactive protein/albumin ratio differed statistically significantly in terms of gender, histopathological subtype, history of smoking, and metastatic site (p<0.05). Correlation analysis showed that C-reactive protein/albumin ratio was negatively correlated with advanced lung cancer inflammation index (r=-0.433, p<0.001) and positively correlated with the other four indices (neutrophil/lymphocyte ratio: r=0.368, p<0.001; platelet/lymphocyte ratio: r=0.321, p<0.001; Glasgow Prognostic Score: r=0.537, p<0.001; and prognostic nutritional index: r=0.223, p=0.003).

CONCLUSION: Our findings show that among the investigated inflammatory indices, C-reactive protein/albumin ratio has the highest prognostic value in patients with metastatic non-small cell lung cancer.

KEYWORDS:
Non-small cell lung cancer; Inflammation; Inflammatory markers; Prognosis; Correlation

		n=179 (%)
Age (years) (median, range)		64 (27–84)
Gender
	Female	28 (15.6)
	Male	151 (84.4)
ECOG performance status
	0–1	127 (70.9)
	≥2	52 (29.1)
Tumor localization
	Right	101 (56.4)
	Left	78 (43.6)
Histopathological subtype
	Adenocarcinoma	130 (72.6)
	Squamous cell carcinoma	38 (21.3)
	Other	11 (6.1)
Metastatic sites
	Liver	6 (3.4)
	Brain	8 (4.5)
	Adrenal	9 (5)
	Lung	21 (11.7)
	Bone	26 (14.5)
	Multiple	86 (48)
	Other sites	23 (12.9)
EGFR mutation positivity		26 (14.5)
ALK mutation positivity		4 (2.2)
First-line treatment (n=150)
	Chemotherapy	127 (84.4)
	Erlotinib	21 (11.7)
	Alectinib	2 (1.1)
Smoking
	Yes	119 (66.5)
	No	32 (17.9)
	Unknown	28 (15.6)
Comorbid disease (n=53)
	Diabetes mellitus	14 (7.8)
	Hypertension	23 (12.8)
	Coronary artery disease	16 (8.9)
Hemoglobin (g/dL)
	≤11	22 (12.3)
	>11	157 (87.7)
CAR
	≤1	88 (49.2)
	>1	91 (50.8)
ALI
	≤21.4	97 (54.2)
	>21.4	82 (45.8)
NLR
	≤3.5	88 (49.2)
	>3.5	91 (50.8)

		Univariate analysis			Multivariate analysis
		HR	95%CI	p-value	HR	95%CI	p-value
Age at diagnosis		1.01	0.99–1.02	0.155
Gender (female/male)		0.68	0.44–1.05	0.088
ECOG PS (0–1/≥2)		1.45	1.12–1.87	0.004	1.37	1.06–1.77	0.016
Tumor localization (right/left)		1.06	0.77–1.47	0.69
Presence of driver mutations		0.48	0.27–0.84	0.011
Histopathological subtype		0.99	0.81–1.22	0.99
Metastatic site		0.01	0.91–1.11	0.84
Smoking		1.40	0.92–2.14	0.115
Hemoglobin level		0.96	0.88–1.05	0.40
GPS		1.18	0.94–1.47	0.14
PLR		1.00	0.99–1.01	0.98
PNI		1.00	0.99–1.02	0.21
CAR		1.15	1.05–1.26	0.002	1.13	1.03–1.24	0.010
	Low (≤1) (n=88)
	High (>1) (n=91)
ALI		0.98	0.97–1.00	0.04
	Low (≤21.4) (n=97)
	High (>21.4) (n=82)
NLR		1.07	1.01–1.12	0.008
	Low (≤3.5) (n=88)
	High (>3.5) (n=91)

		All patients n (%)	CAR		p-value
		All patients n (%)	Low, n=88 (49.1%)	High, n=91 (50.8%)	p-value
Age (mean±std. dev.)		63.5±11.6	63.9±12.2	63.2±11.2	0.69*
Gender
	Female	28 (15.6)	20 (71.4)	8 (28.6)	0.01 **
	Male	151 (84.4)	68 (45)	83 (55)	0.01 **
ECOG performance status
	0–1	127 (70.9)	63 (52.1)	58 (47.9)	0.15**
	≥2	52 (29.1)	21 (40.4)	31 (59.6)	0.15**
Tumor localization
	Right lung	101 (56.4)	49 (48.5)	52 (51.5)	0.93**
	Left lung	78 (43.6)	34 (47.9)	37 (52.1)	0.93**
Histopathological subtype
	Adenocarcinoma	130 (72.6)	69 (53.1)	61 (46.9)	0.04 **
	Squamous cell carcinoma	38 (21.3)	12 (31.6)	26 (68.4)
	Other	11 (6.1)	7 (63.6)	4 (36.4)
EGFR mutation (n=78)
	Yes	26 (33.3)	18 (69.2)	8 (30.8)	0.19**
	No	52 (66.7)	28 (53.8)	24 (46.2)	0.19**
ALK mutation (n=29)
	Yes	4 (13.8)	1 (25)	3 (75)	0.29***
	No	25 (86.2)	15 (60)	10 (40)	0.29***
First-line treatment (n=150)
	Chemotherapy	127 (84.4)	61 (48)	66 (52)	0.12**
	Targeted therapy	23 (17.7)	15 (65.2)	8 (34.8)	0.12**
Smoking history
	Yes	119 (66.5)	50 (42)	69 (58)	0.01 **
	No	32 (17.9)	23 (71.9)	9 (28.1)
	Unknown	28 (15.6)	15 (53.6)	13 (46.4)
Comorbid disease (n=53)
	Diabetes mellitus (yes)	14	6 (42.9)	8 (57.1)	0.66**
	Hypertension (yes)	23	12 (52.2)	11 (47.8)	0.71**
	Coronary artery disease (yes)	16	7 (43.8)	9 (56.3)	0.88**
Metastatic site
	Visceral	44 (24.6)	30 (68.2)	14 (31.8)	0.005 *
	Non-visceral	49 (27.4)	25 (51)	24 (49)
	Multiple	86 (48)	33 (38.4)	53 (61.6)

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[TFN1] NLR: neutrophil/lymphocyte ratio; ALI: advanced lung cancer inflammation index; CAR: C-reactive protein/albumin ratio; ECOG: Eastern Cooperative Oncology Group; EGFR: epidermal growth factor receptor; ALK: anaplastic lymphoma kinase.