The prognostic potential of an immunology score in patients treated with curative surgery for non-small cell lung cancer

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PURPOSE: Curative surgery is the best treatment for patients with early-stage non-small cell lung cancer (NSCLC), but around 40% experience recurrence impacting survival. Does the individual immunological status affect the prognosis? This study investigated four immunology markers in relation to recurrence and survival after curative surgery for NSCLC. METHODS: Natural Killer cell activity (NKA), C-reactive protein (CRP), Interleukin 6 (IL6) and Transforming growth factor beta (TGFβ) were analysed before surgery and at three months after surgery for NSCLC. RESULTS: Of the 103 enrolled patients, 43 experienced recurrence over a period of median 71 months. The biomarkers were unsuitable for detecting recurrence with area under the receiver operating characteristics curve ranging from 0.52 to 0.58. Baseline CRP and TGFβ were significantly associated with overall survival (OS), and a score based on all four biomarkers demonstrated statistically significant prognostic impact on both recurrence free survival (RFS) and OS. The biomarker score was an independent prognostic factor when adjusting for stage and surgery type, hazard ratio 3.18 (95% CI 1.53-6.61, p = 0.002) for OS with borderline significance for RFS, hazard ratio 1.93 (95% CI 1.06-3.51, p = 0.032). CONCLUSION: Individually, NKA, CRP, IL6 and TGFβ were not suited for predicting disease recurrence after curative surgery for NSCLC. However, the combined biomarker score was significantly associated with OS. The score may give an indication of the immunological status of the patient, which could be useful for pre- or post-surgery assessment, in relation to immunotherapy or other oncologic treatments if future studies can prove clinical utility.

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