Impact of pre-operative inflammatory markers on overall and disease-free survival of octogenarian patients undergoing video-assisted thoracoscopic lobectomy for early-stage lung cancer: a multicenter study

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Background: The proportion of octogenarian patients who undergo surgery for lung cancer is growing over recent years. Elderly patients are characterized by age-related changes, such as inflammatory modifications of the lower respiratory tract, responsible for structural and functional alterations and tumor progression. Inflammatory markers (IMs) are a well-known prognostic factor in several tumor types, but they have not been analyzed extensively in octogenarian patients submitted to thoracoscopic lobectomy for early-stage lung cancer. The aim of our study is to assess the impact of the pre-operative IMs on the overall survival (OS), disease-free survival (DFS), and post-operative complications of this subset of patients. Methods: We conducted a retrospective and multi-institutional study. All octogenarian patients submitted to thoracoscopic lobectomy for early-stage lung cancer from January 2013 to April 2019 were enrolled. Pre-operative cellular IMs were measured in peripheral blood samples and their cut-off values were set according to previous findings in literature. Cox regression model was used to analyze the relationship between IMs, and OS and DFS. Kaplan-Meier method was used to calculate the OS and DFS rates. The follow-up period was 36 months. All P values lower than 0.05 were considered statistically significant. Results: A total of 118 patients were included. At multivariate analysis adjusted by sex, age, and chronic obstructive pulmonary disease (COPD), neutrophils-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) were strongly associated with higher risk of mortality [hazard ratio (HR) 2.89, 95% confidence interval (CI): 1.05-8.02, P=0.04, HR 2.74, 95% CI: 1.15-6.52, P=0.02, respectively]. NLR >2.5 and CRP >3 were associated with worse survival (respectively P=0.02 and P=0.02). Higher levels of monocyte-to-lymphocyte ratio (MLR) were still associated with a higher mortality rate, although more weakly (P=0.056). Conclusions: Elevated pre-operative NLR and CRP can be considered as a prognostic indicator in patients with non-small cell lung cancer (NSCLC) undergoing surgery with minimally invasive approach. Post-operative course and DFS is not influenced by pre-operative IMs levels.

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