Pre-diagnosis neutrophil-to-lymphocyte ratio and mortality in individuals who develop lung cancer

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Abstract
Purpose The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been reported to be associated with survival after chronic disease diagnoses, including lung cancer. We hypothesized that the inflammatory profile reflected by pre-diagnosis NLR, rather than the well-studied pre-treatment NLR at diagnosis, may be associated with increased mortality after lung cancer is diagnosed in high risk heavy smokers.Methods We examined associations between pre-diagnosis methylation derived-NLR (mdNLR) and lung cancer-specific and all-cause mortality in 372 lung cancer cases from the β-Carotene and Retinol Efficacy Trial (CARET). Cox proportional hazards models were adjusted for age, sex, smoking status, pack years, and time between blood draw and diagnosis, and stratified by stage of disease. Models were run separately by histotype.Results Among those who developed small cell lung cancer (SCLC, N = 81), individuals with pre-diagnosis mdNLR in the highest quartile had 2.5-fold increased mortality compared to those in the lowest quartile. For each unit increase in pre-diagnosis mdNLR, we observed 22–23% increased mortality in SCLC (SCLC-specific hazard ratio [HR] = 1.23, 95% confidence interval [CI]: 1.02, 1.48; all-cause HR = 1.22, 95% CI: 1.01, 1.46). SCLC associations were strongest for current smokers at blood draw (Interaction Ps = 0.03). mdNLR was not associated with mortality for individuals diagnosed with adenocarcinoma (N = 148) or squamous cell carcinoma (N = 115).Conclusion Our findings suggest that increased mdNLR, representing a systemic inflammatory profile on average 4.5 years before a SCLC diagnosis, may be associated with mortality in heavy smokers who go on to develop SCLC but not other lung cancer histotypes.