Preoperative systemic inflammatory indices predict disease-free survival after curative-intent resection for non-small-cell lung cancer.
- 1Faculty of Medicine, Department of Thoracic Surgery, Istanbul Aydın University, VM Medical Park Florya Hospital, Beşyol, Florya, Akasya Sk. No:4 D:1, Küçükçekmece , Istanbul, 34295, Turkey. [email protected].
- 2Faculty of Medicine, Department of Medical Oncology, Istanbul Aydın University, VM Medical Park Florya Hospital, Istanbul, Turkey.
- 3Faculty of Medicine, Department of Medical Oncology, Istinye University, Istanbul, Turkey.
Abstract
Background
Systemic inflammation plays a crucial role in cancer progression and may influence outcomes after surgical treatment. Blood count-derived inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) have been proposed as prognostic biomarkers in several malignancies. However, their prognostic value in surgically treated non-small-cell lung cancer (NSCLC), particularly for recurrence-related outcomes, remains incompletely defined.Methods
We retrospectively analyzed 132 patients with histologically confirmed NSCLC who underwent curative-intent anatomical lung resection between January 2022 and December 2025. Preoperative inflammatory markers (NLR, PLR, SII) were calculated from blood counts obtained within 14 days before surgery. Associations with clinicopathologic features, postoperative complications, and disease-free survival (DFS) were assessed using non-parametric tests, Kaplan-Meier survival analysis, Cox proportional hazards regression, and receiver operating characteristic (ROC) curve analysis.Results
The median age was 64.5 years and 64.4% of patients were male. Adenocarcinoma cases demonstrated higher lymphocyte counts and lower PLR compared with non-adenocarcinoma tumors. Inflammatory indices increased significantly with advancing tumor size-based T category. During follow-up, 20 DFS events were observed. In univariable Cox regression, higher log-transformed NLR (HR 2.34, 95% CI 1.09-5.01; p = 0.029), PLR (HR 2.56, 95% CI 1.12-5.89; p = 0.027), and SII (HR 2.06, 95% CI 1.14-3.74; p = 0.017) were associated with shorter DFS. In the primary multivariable model, logNLR remained associated with recurrence risk (adjusted HR 2.18, 95% CI 1.01-4.72; p = 0.046). In a pre-specified Firth penalized stage-adjusted sensitivity analysis, this association was attenuated and no longer statistically significant (adjusted HR 2.05, 95% CI 0.94-4.44), indicating substantial overlap between NLR and tumour stage. ROC analysis demonstrated moderate predictive performance of NLR for DFS events (AUC 0.67). An exploratory cutoff analysis suggested that NLR values above 2.0 were associated with worse DFS.Conclusion
Preoperative systemic inflammatory indices are associated with tumor burden and disease-free survival in surgically treated NSCLC. Among the evaluated markers, NLR demonstrated the most consistent prognostic signal. These findings support further investigation of inflammation-based biomarkers as adjunct tools for recurrence risk stratification in operable lung cancer.Clinical trial registration
We confirm that our study is not a clinical trial. "Clinical trial number not applicable."
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BibTeX
@article{kolbas2026preoperative,
title = {{Preoperative systemic inflammatory indices predict disease-free survival after curative-intent resection for non-small-cell lung cancer.}},
author = {Ilker Kolbas and Tuncay Koc and Irfan Cicin},
journal = {BMC pulmonary medicine},
year = {2026},
month = aug,
doi = {10.1186/s12890-026-04589-1},
url = {https://europepmc.org/article/MED/43009908},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Preoperative systemic inflammatory indices predict disease-free survival after curative-intent resection for non-small-cell lung cancer.
AU - Ilker Kolbas
AU - Tuncay Koc
AU - Irfan Cicin
PY - 2026
DA - 2026/08/14
JO - BMC pulmonary medicine
DO - 10.1186/s12890-026-04589-1
UR - https://europepmc.org/article/MED/43009908
AB - Background Systemic inflammation plays a crucial role in cancer progression and may influence outcomes after surgical treatment. Blood count-derived inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) have been proposed as prognostic biomarkers in several malignancies. However, their prognostic value in surgically treated non-small-cell lung cancer (NSCLC), particularly for recurrence-related outcomes, remains incompletely defined.Methods We retrospectively analyzed 132 patients with histologically confirmed NSCLC who underwent curative-intent anatomical lung resection between January 2022 and December 2025. Preoperative inflammatory markers (NLR, PLR, SII) were calculated from blood counts obtained within 14 days before surgery. Associations with clinicopathologic features, postoperative complications, and disease-free survival (DFS) were assessed using non-parametric tests, Kaplan-Meier survival analysis, Cox proportional hazards regression, and receiver operating characteristic (ROC) curve analysis.Results The median age was 64.5 years and 64.4% of patients were male. Adenocarcinoma cases demonstrated higher lymphocyte counts and lower PLR compared with non-adenocarcinoma tumors. Inflammatory indices increased significantly with advancing tumor size-based T category. During follow-up, 20 DFS events were observed. In univariable Cox regression, higher log-transformed NLR (HR 2.34, 95% CI 1.09-5.01; p = 0.029), PLR (HR 2.56, 95% CI 1.12-5.89; p = 0.027), and SII (HR 2.06, 95% CI 1.14-3.74; p = 0.017) were associated with shorter DFS. In the primary multivariable model, logNLR remained associated with recurrence risk (adjusted HR 2.18, 95% CI 1.01-4.72; p = 0.046). In a pre-specified Firth penalized stage-adjusted sensitivity analysis, this association was attenuated and no longer statistically significant (adjusted HR 2.05, 95% CI 0.94-4.44), indicating substantial overlap between NLR and tumour stage. ROC analysis demonstrated moderate predictive performance of NLR for DFS events (AUC 0.67). An exploratory cutoff analysis suggested that NLR values above 2.0 were associated with worse DFS.Conclusion Preoperative systemic inflammatory indices are associated with tumor burden and disease-free survival in surgically treated NSCLC. Among the evaluated markers, NLR demonstrated the most consistent prognostic signal. These findings support further investigation of inflammation-based biomarkers as adjunct tools for recurrence risk stratification in operable lung cancer.Clinical trial registration We confirm that our study is not a clinical trial. "Clinical trial number not applicable."
SN - 1471-2466
ER -