World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 9, Number 3, June 2018, pages 85-90

Comparison of Inflammation-Based Prognostic Scores in Patients undergoing Curative Resection for Non-small Cell Lung Cancer

Figure 1. (a) Overall postoperative cancer-specific survival of patients based on Glasgow prognostic score (GPS, P < 0.001); (b) neutrophil-to-lymphocyte ratio (NLR, P < 0.001); (c) platelet-to-lymphocyte ratio (PLR, P < 0.001); (d) prognostic nutritional index (PNI, P = 0.014); (e) systemic immune-inflammation index (SII, P < 0.001); (f) advance lung cancer inflammation index (ALI, P < 0.001).

Figure 2. Comparison of the area under the receiver operating characteristics (ROC) for outcome prediction between the inflammation-based prognostic scores.

**Table 1.** Inflammation-Based Prognostic Scores
	Score
Glasgow Prognostic Score (GPS)
C-reactive protein ≤ 10 mg/L and albumin ≥ 35 g/L	0
C-reactive protein ≤ 10 mg/L and albumin < 35 g/L	1
C-reactive protein > 10 mg/L and albumin ≥ 35 g/L	1
C-reactive protein > 10 mg/L and albumin < 35 g/L	2
Neutrophil lymphocyte ratio (NLR)
Neutrophil count/lymphocyte count < 5:1	Low
Neutrophil count/lymphocyte count ≥ 5:1	High
Platelet lymphocyte ratio (PLR)
Platelet count/lymphocyte count < 150:1	0
Platelet count/lymphocyte count 150 - 300	1
Platelet count/lymphocyte count > 300:1	2
Prognostic nutritional index (PNI)
Albumin (g/L) + 5 × total lymphocyte count ≥ 45	0
Albumin (g/L) + 5 × total lymphocyte count < 45	1
Systemic immune-inflammation index (SII)
Platelet count × NLR < cut-off value	Low
Platelet count × NLR ≥ cut-off value	High
Advance lung cancer inflammation index (ALI)
Body mass index × albumin/NLR ≥ cut-off value	Low
Body mass index × albumin/NLR < cut-off value	High

Table 1. Inflammation-Based Prognostic Scores

Score

Glasgow Prognostic Score (GPS)

C-reactive protein ≤ 10 mg/L and albumin ≥ 35 g/L

C-reactive protein ≤ 10 mg/L and albumin < 35 g/L

C-reactive protein > 10 mg/L and albumin ≥ 35 g/L

C-reactive protein > 10 mg/L and albumin < 35 g/L

Neutrophil lymphocyte ratio (NLR)

Neutrophil count/lymphocyte count < 5:1

Low

Neutrophil count/lymphocyte count ≥ 5:1

High

Platelet lymphocyte ratio (PLR)

Platelet count/lymphocyte count < 150:1

Platelet count/lymphocyte count 150 - 300

Platelet count/lymphocyte count > 300:1

Prognostic nutritional index (PNI)

Albumin (g/L) + 5 × total lymphocyte count ≥ 45

Albumin (g/L) + 5 × total lymphocyte count < 45

Systemic immune-inflammation index (SII)

Platelet count × NLR < cut-off value

Low

Platelet count × NLR ≥ cut-off value

High

Advance lung cancer inflammation index (ALI)

Body mass index × albumin/NLR ≥ cut-off value

Low

Body mass index × albumin/NLR < cut-off value

High

**Table 2.** The Relationships Between Clinical Characteristics and Each Inflammation-Based Score
	GPS	NLR	SII
GPS: Glasgow prognostic score; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; PNI: prognostic nutritional index; SII: systemic immune-inflammation index; ALI: advance lung cancer inflammation index; CEA: carcinoembryonic antigen; CYFRA21-1: cytokeratin 19 fragments.
Age (years old)	< 65	68	31	7	0.063	98	8	0.222	62	44	0.276
	≥ 65	123	81	31		225	10		152	83
Gender	Male	83	65	25	0.007	158	15	0.003	93	80	0.001
	Female	108	47	13		165	3		121	47
Smoking	Never	109	40	9	<0.001	154	4	0.029	114	44	0.001
	Current/former	82	72	29		169	14		100	83
Histology	Adeno	163	81	24	0.002	258	10	0.024	182	86	< 0.001
	Others	28	31	14		65	8		32	41
pStage	I	150	91	24	0.081	256	9	0.008	178	87	< 0.001
	II - III	41	21	14		67	9		36	40
pT status	pT1	136	82	17	0.004	227	8	0.027	157	78	0.022
	pT2-3	55	30	21		96	10		57	49
pN status	pN0	163	100	29	0.162	281	11	0.008	192	100	0.006
	pN1-2	28	12	9		42	7		22	27
CEA	Normal	146	84	24	0.250	241	13	0.822	159	95	0.918
	High	45	28	14		82	5		55	32
CYFRA	Normal	166	91	26	0.026	272	11	0.023	181	102	0.314
	High	25	21	12		51	7		33	25
GPS: Glasgow prognostic score; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; PNI: prognostic nutritional index; SII: systemic immune-inflammation index; ALI: advance lung cancer inflammation index; CEA: carcinoembryonic antigen; CYFRA21-1: cytokeratin 19 fragments.
Age	< 65	62	40	4	0.084	82	24	0.001	37	69	0.941
	≥ 65	166	61	8		138	97		83	152
Gender	Male	106	58	9	0.040	109	64	0.554	73	100	0.006
	Female	122	43	3		111	57		47	121
Smoking	Never	114	41	3	0.086	105	53	0.486	43	115	0.004
	Current/former	114	60	9		115	68		77	106
Histology	Adeno	185	75	8	0.235	175	93	0.565	82	186	0.001
	Others	43	26	4		45	28		38	35
pStage	I	186	73	6	0.018	170	95	0.792	83	182	0.006
	II - III	42	28	6		50	26		37	39
pT status	pT1	162	68	5	0.111	157	78	0.190	76	159	0.103
	pT2-3	66	33	7		63	43		44	62
pN status	pN0	203	81	8	0.027	191	101	0.403	95	197	0.014
	pN1-2	25	20	4		29	20		25	24
CEA	Normal	171	74	9	0.946	169	85	0.186	87	167	0.537
	High	57	27	3		51	36		33	54
CYFRA	Normal	194	80	9	0.334	190	93	0.028	89	194	0.002
	High	34	21	3		30	28		31	27

Table 2. The Relationships Between Clinical Characteristics and Each Inflammation-Based Score

GPS

NLR

SII

GPS 0

GPS 1

GPS 2

P value

Low

High

P value

Low

High

P value

GPS: Glasgow prognostic score; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; PNI: prognostic nutritional index; SII: systemic immune-inflammation index; ALI: advance lung cancer inflammation index; CEA: carcinoembryonic antigen; CYFRA21-1: cytokeratin 19 fragments.

Age (years old)

< 65

0.063

0.222

0.276

≥ 65

123

225

152

Gender

Male

0.007

158

0.003

0.001

Female

108

165

121

Smoking

Never

109

<0.001

154

0.029

114

0.001

Current/former

169

100

Histology

Adeno

163

0.002

258

0.024

182

< 0.001

Others

pStage

150

0.081

256

0.008

178

< 0.001

II - III

pT status

pT1

136

0.004

227

0.027

157

0.022

pT2-3

pN status

pN0

163

100

0.162

281

0.008

192

100

0.006

pN1-2

CEA

Normal

146

0.250

241

0.822

159

0.918

High

CYFRA

Normal

166

0.026

272

0.023

181

102

0.314

High

PLR

PNI

ALI

PLR 0

PLR 1

PLR 2

P value

PNI 0

PNI 1

P value

Low

High

P value

Age

< 65

0.084

0.001

0.941

≥ 65

166

138

152

Gender

Male

106

0.040

109

0.554

100

0.006

Female

122

111

121

Smoking

Never

114

0.086

105

0.486

115

0.004

Current/former

114

115

106

Histology

Adeno

185

0.235

175

0.565

186

0.001

Others

pStage

186

0.018

170

0.792

182

0.006

II - III

pT status

pT1

162

0.111

157

0.190

159

0.103

pT2-3

pN status

pN0

203

0.027

191

101

0.403

197

0.014

pN1-2

CEA

Normal

171

0.946

169

0.186

167

0.537

High

CYFRA

Normal

194

0.334

190

0.028

194

0.002

High

**Table 3.** Univariate and Multivariate Analyses
	Univariate	Multivariate
GPS: Glasgow prognostic score; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; PNI: prognostic nutritional index; SII: systemic immune-inflammation index; ALI: advance lung cancer inflammation index; CEA: carcinoembryonic antigen; CYFRA21-1: cytokeratin 19 fragments; CI: confidence interval.
Age	0.755	0.235	0.461	1.193
Gender	0.329	< 0.001	0.204	0.514	0.367	0.003	0.183	0.717
Smoking status	0.349	< 0.001	0.215	0.549	0.696	0.323	0.344	1.435
Histology	0.250	< 0.001	0.165	0.382	0.439	0.001	0.271	0.715
pT status	0.450	< 0.001	0.298	0.683	0.958	0.866	0.590	1.580
pN status	0.330	< 0.001	0.211	0.534	0.409	0.002	0.242	0.704
CEA	0.382	< 0.001	0.252	0.586	0.446	0.001	0.287	0.702
CYFRA21-1	0.353	< 0.001	0.229	0.556	0.835	0.502	0.501	1.428
GPS	0.409	< 0.001	0.265	0.622	0.499	0.009	0.296	0.838
NLR	0.309	0.003	0.168	0.635	0.963	0.922	0.472	2.139
PLR	0.462	< 0.001	0.306	0.698	0.834	0.532	0.471	1.473
PNI	0.599	0.017	0.396	0.910	0.772	0.346	0.449	1.323
SII	0.368	< 0.001	0.241	0.556	0.927	0.841	0.444	1.920
ALI	0.312	< 0.001	0.204	0.473	0.444	0.026	0.217	0.907

Table 3. Univariate and Multivariate Analyses

Univariate

Multivariate

Hazard ratio

P value

95% CI

Hazard ratio

P value

95% CI

Lower

Upper

Lower

Upper

Age

0.755

0.235

0.461

1.193

Gender

0.329

< 0.001

0.204

0.514

0.367

0.003

0.183

0.717

Smoking status

0.349

< 0.001

0.215

0.549

0.696

0.323

0.344

1.435

Histology

0.250

< 0.001

0.165

0.382

0.439

0.001

0.271

0.715

pT status

0.450

< 0.001

0.298

0.683

0.958

0.866

0.590

1.580

pN status

0.330

< 0.001

0.211

0.534

0.409

0.002

0.242

0.704

CEA

0.382

< 0.001

0.252

0.586

0.446

0.001

0.287

0.702

CYFRA21-1

0.353

< 0.001

0.229

0.556

0.835

0.502

0.501

1.428

GPS

0.409

< 0.001

0.265

0.622

0.499

0.009

0.296

0.838

NLR

0.309

0.003

0.168

0.635

0.963

0.922

0.472

2.139

PLR

0.462

< 0.001

0.306

0.698

0.834

0.532

0.471

1.473

PNI

0.599

0.017

0.396

0.910

0.772

0.346

0.449

1.323

SII

0.368

< 0.001

0.241

0.556

0.927

0.841

0.444

1.920

ALI

0.312

< 0.001

0.204

0.473

0.444

0.026

0.217

0.907