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      Inflammation‐based prognostic scoring system for predicting the prognosis of advanced small cell lung cancer patients receiving anlotinib monotherapy

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          Abstract

          Background

          According to the randomized multicenter phase II trial (ALTER1202), anlotinib has been approved as a third‐line therapy for advanced small‐cell lung cancer (SCLC). Some studies showed the predictive function of inflammatory markers, including neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and lymphocyte‐to‐monocyte ratio (LMR) in the different cancers treated with anti‐vascular targeting drugs. However, none of the studies showed the roles of NLR, PLR, and LMR in SCLC patients receiving anlotinib. Thus, our objective was to establish a scoring system based on inflammation to individuate patient stratification and selection based on NLR, PLR, and LMR.

          Methods

          NLR, PLR, and LMR and their variations were calculated in 53 advanced SCLC patients receiving anlotinib as a third‐ or further‐line treatment at Ningbo Medical Center Lihuili Hospital between January 2019 and December 2021. Kaplan–Meier curves were plotted. Both univariate and multivariate Cox regressions were used to identify predictors of survival.

          Results

          Disease control rate was related to pre‐NLR, pre‐PLR, pre‐LMR, post‐NLR elevation, post‐PLR elevation, and post‐LMR elevation. The multivariate analysis determined post‐NLR elevation, pre‐PLR > 240.56, and pre‐LMR ≤1.61 to be independently associated with progression‐free survival, not overall survival. The inflammation‐based prognostic scoring system demonstrated favorable predictive ability from the receiver operating characteristic curve (AUC: 0.791, 95% CI: 0.645–0.938).

          Conclusions

          Post‐NLR variation, pre‐PLR, and pre‐LMR were independent prognostic factors for PFS in advanced SCLC receiving anlotinib monotherapy. The inflammation‐based prognostic scoring system can accurately predict effectiveness and survival.

          Abstract

          Progression‐free survival and overall survival according to the inflammation‐based prognostic scoring system (A, p = 0.001), (B, p < 0.001), (C, p < 0.001), (D, p = 0.008), (E, p < 0.001), (F, p = 0.004) based on post‐NLR elevation (+1), pre‐PLR 〉 240.56 (+1) and pre‐LMR ≤ 1.61 (+1).

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          Most cited references26

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          Cancer statistics, 2022

          Rebecca Siegel, Kimberly D Miller, Hannah Fuchs … (2022)
          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes. Incidence data (through 2018) were collected by the Surveillance, Epidemiology, and End Results program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized-stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized-stage diagnoses (from 17% in 2004 to 28% in 2018) and 3-year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality.
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            Cancer-related inflammation.

            Alberto Mantovani, Paola Allavena, Antonio Sica … (2008)
            The mediators and cellular effectors of inflammation are important constituents of the local environment of tumours. In some types of cancer, inflammatory conditions are present before a malignant change occurs. Conversely, in other types of cancer, an oncogenic change induces an inflammatory microenvironment that promotes the development of tumours. Regardless of its origin, 'smouldering' inflammation in the tumour microenvironment has many tumour-promoting effects. It aids in the proliferation and survival of malignant cells, promotes angiogenesis and metastasis, subverts adaptive immune responses, and alters responses to hormones and chemotherapeutic agents. The molecular pathways of this cancer-related inflammation are now being unravelled, resulting in the identification of new target molecules that could lead to improved diagnosis and treatment.
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              The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer.

              Graeme J. K. Guthrie, Kellie A. Charles, Campbell Roxburgh … (2013)
              There is increasing and consistent evidence that cancer-associated inflammation is a key determinant of outcome in patients with cancer. Various markers of inflammation have been examined over the past decade in an attempt to refine stratification of patients to treatment and predict survival. One routinely available marker of the systemic inflammatory response is the neutrophil-lymphocyte ratio (NLR), which is derived from the absolute neutrophil and absolute lymphocyte counts of a full blood count. To date, over 60 studies (>37,000 patients) have examined the clinical utility of the NLR to predict patient outcomes in a variety of cancers. The present systematic review examines and comments on the clinical utility of the NLR. The NLR had independent prognostic value in (a) unselected cohorts (1 study of >12,000 patients), (b) operable disease (20 studies, >4000 patients), (c) patients receiving neoadjuvant treatment and resection (5 studies, >1000 patients), (d) patients receiving chemo/radiotherapy (12 studies, >2000 patients) and (e) patients with inoperable disease (6 studies, >1200 patients). These studies originated from ten different countries, in particular UK, Japan, and China. Further, correlative studies (15 studies, >8500 patients) have shown that NLR is elevated in patients with more advanced or aggressive disease evidenced by increased tumour stage, nodal stage, number of metastatic lesions and as such these patients may represent a particularly high-risk patient population. Further studies investigating the tumour and host-derived factors regulating the systemic inflammatory response, in particular the NLR, may identify novel treatment strategies for patients with cancer. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Contributors
                Weiyu Shen: nblhlswy@163.com
                Journal
                Journal ID (nlm-ta): J Clin Lab Anal
                Journal ID (iso-abbrev): J Clin Lab Anal
                Journal ID (doi): 10.1002/(ISSN)1098-2825
                Journal ID (publisher-id): JCLA
                Title: Journal of Clinical Laboratory Analysis
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0887-8013
                ISSN (Electronic): 1098-2825
                Publication date (Electronic): 28 November 2022
                Publication date Collection: December 2022
                Volume: 36
                Issue: 12 ( doiID: 10.1002/jcla.v36.12 )
                Electronic Location Identifier: e24772
                Affiliations
                [ 1 ] Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital Ningbo University Ningbo China
                [ 2 ] Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital Ningbo University Ningbo China
                [ 3 ] Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital Ningbo University Ningbo China
                Author notes
                [*] [* ] Correspondence

                Weiyu Shen, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China.

                Email: nblhlswy@ 123456163.com

                Author information
                https://orcid.org/0000-0001-8490-600X
                Article
                Publisher ID: JCLA24772 Other ID: JCLA-22-2549.R2
                DOI: 10.1002/jcla.24772
                PMC ID: 9757002
                PubMed ID: 36441595
                SO-VID: c2965b35-8e0a-43c4-8950-a0e4c0e44fc2
                Copyright © © 2022 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date revision received : 23 October 2022
                Date received : 09 September 2022
                Date accepted : 05 November 2022
                Page count
                Figures: 10, Tables: 5, Pages: 13, Words: 4889
                Funding
                Funded by: major science and technology innovation in 2025 projects of Ningbo
                Award ID: 2019B10039
                Funded by: Ningbo Clinical Research Center for thoracic & breast neoplasms
                Award ID: 2021L002
                Categories
                Subject: Research Article
                Subject: Research Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date December 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.3 mode:remove_FC converted:16.12.2022

                ScienceOpen disciplines: Clinical chemistry
                Keywords: anlotinib,neutrophil to lymphocyte ratio (nlr),platelet lymphocyte ratio (plr),prognostic scoring system,small‐cell lung cancer (sclc)
                Data availability:
                ScienceOpen disciplines: Clinical chemistry
                Keywords: anlotinib, neutrophil to lymphocyte ratio (nlr), platelet lymphocyte ratio (plr), prognostic scoring system, small‐cell lung cancer (sclc)

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