The predictive value of pre-treatment inflammatory markers in advanced non-small-cell lung cancer

G. Kasymjanova, N. MacDonald, J.S. Agulnik, V. Cohen, C. Pepe, H. Kreisman, R. Sharma, D. Small



Accurate prediction of outcome in advanced non-small-cell lung cancer (NSCLC) remains challeng­ing. Even within the same stage and treatment group, survival and response to treatment vary. We set out to determine the predictive value of inflammatory markers C-reactive protein (CRP) and white blood cells (WBCS) in patients with advanced NSCLC.

Patients and Methods

Patients were assigned a prognostic index (PI):

  • 0 for CRP 10 mg/L or less and wbcs 11×109/L or less,
  • 1 if one of the two markers was elevated, and
  • 2 if both markers were elevated.

We then used chest computed tomography (CT) imaging to evaluate response after 2 cycles of che­motherapy treatment.


Of 134 patients, 46 had a PI of 0; 60, a PI of 1; and 28, a PI of 2. Disease progressed in 41 patients. Progression was significantly more frequent among patients with a PI of 2 (p = 0.008). Median survival was 20.0 months for the PI 0 group, 10.4 months for the PI 1 group, and 7.9 months for the PI 2 group (p < 0.001). The pi was the only significant prognostic factor for survival even after adjustment for performance status, smoking, and weight loss (hazard ratio: 1.57; 95% confidence interval: 1.2 to 2.14; p = 0.004).


Inflammatory state correlates significantly with both chemotherapy response and survival in stage IV NSCLC. The PI may provide additional guidance for therapeutic decision-making.

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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)