Neutrophil-to-Lymphocyte Ratio May Guide the Choice of Treatment in Metastatic Cancer Patients: Chemotherapy or Best Supportive Care

Aim: We set out in this study to investigate whether the neutrophil-to-lymphocyte ratio (NLR) is a predictor in deciding whether to either continue palliative chemotherapy or choose the best supportive care (BSC) for advanced cancer patients. Methods: Those with advanced solid tumors who had died after palliative chemotherapy were included the study. The patients were divided into two groups based on the time between the beginning of their last chemotherapy regimen and death (DCD), at ≤ 60 or > 60 days. Neutrophil-to-lymphocyte ratio was calculated using the laboratory values taken before the beginning of the last chemotherapy line. The determinant factors of ≤ 60-days DCD were examined by logistic regression analysis, and a statistical significance level of alpha was accepted as p < 0.05. Results: The study included 404 patients, with the mean age at diagnosis of 61.7±12.0 years. The mean NLR was calculated as 11.3±27.1. In the univariate analysis for determining ≤ 60-days DCD, breast and colorectal cancers, ECOG status, single agent chemotherapy usage, neutrophil count, lymphocyte count and NLR were all found to be significant factors. The cutoff value determining the ≤ 60-days DCD, was determined as NLR ≥ 3.59. In logistic regression analysis, NLR ≥ 3.59, as well as ECOG status, were found to be significant factors. Conclusion: The neutrophil-lymphocyte ratio, combined with ECOG, can predict survival in patients with solid advanced tumors and can therefore help clinicians in choosing to either administer chemotherapy to their patients or direct them to the best supportive care.