Disparate influence of pretreatment neutrophil-lymphocyte ratio and systemic immune-inflammation index on survival of EGFR-mutated against ALK/ROS1 rearranged metastatic non-small cell lung cancer — implications beyond the prognosis?

Introduction. The purpose of this study is to evaluate the influence of the neutrophil-lymphocyte ratio (NLR) and the systemic immune-inflammation index (SII) on the survival of EGFR-mutated vs. ALK/ROS rearranged non-small cell lung cancer (NSCLC). Material and methods. Only patients with EGFR-mutated (N = 64) or ALK/ROS-rearranged (N = 29) metastatic NSCLC treated with tyrosine kinase inhibitors (TKI) were enrolled. The Cox regression model was used to assess the impact of selected variables on survival, including the influence of NLR and SII. Results. The NLR and SII did not significantly influence survival in patients with EGFR-mutated NSCLC. On the contrary, NLR and SII significantly influenced survival in patients with ALK/ROS rearranged NSCLC. Conclusions. Despite previously accomplished studies on this subject, the influence of inflammatory markers on the outcome of patients treated with TKI deserves further attention. Hypothesized herein is that NLR and SII may be helpful in stratification of patients with ALK/ROS rearrangements for clinical trials on combinations of immune checkpoint inhibitors (ICI) and TKI.