Introduction: Neutrophilia has been associated with many chronic inflammatory lung diseases, lung cancer and systemic inflammatory diseases. A common denominator of inflammation in these entities is Th 17 type of CD4+T cell adaptive immunity. Neutrophil infiltration of tumour microenvironment and peripheral blood neutrophilia has become a focus of attraction in recent research on chronic inflammatory diseases. Many studies have shown that increased neutrophil:lymphocyte ratio(NLR)  and advanced lung cancer inflammation index (ALI) are poor prognostic indicators in cancers.

Aims: This study aims to find out the neutrophil: lymphocyte ratio in lung cancer patients.

Materials and Methods: This study is a retrospective analysis conducted in the Department of Pulmonary medicine in a tertiary care centre in south Kerala. The case records of 50 patients, histologically diagnosed as lung cancer were analysed. NLR was calculated from routine blood examination results.

Results: The total number of patients included in the study was 50.The most common histological type of lung cancer was adenocarcinoma in both males and females of all ages. Neutrophil lymphocyte ratio was high in all patients, irrespective of the histological type. Mean value of NLR was 5.33  (reference range, 2.15 or less) ⁽¹⁾

Conclusion: This study shows that neutrophils are the predominant leukocytes in peripheral blood of lung cancer patients, supporting the concept of ongoing injury and repair processes in the pathogenesis of inflammation in lung cancer. NLR is a simple and inexpensive bed side biomarker of systemic inflammation in lung cancer patients.

Keywords: Lung cancer, neutrophil, lymphocyte, NLR.

1. Forget P, Khalifa C, Defour J-P, Latinne D, Van Pel M-C, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes [Internet]. 2017 Jan;10:12
2. Gosens R, Giangreco A, Sahai E, Chambers RC. Mechanistic overlap between chronic lung injury and cancer: ERS Lung Science Conference 2017 report. Eur Respir Rev. 2017 Jun 30;26(144):170060.
3. Sankowski R, Mader S, Vald és-Ferrer SI. Systemic Inflammation and the Brain: Novel Roles of Genetic, Molecular, and Environmental Cues as Drivers of Neuro degeneration. Front Cell Neurosci. 2015 Feb;9:28.
4. Ocana A, Nieto-Jiménez C, Pandiella A, Templeton AJ. Neutrophils in cancer: prognostic role and therapeutic strategies. Mol Cancer. 2017 Aug;16:137.
5. Gernez Y, Tirouvanziam R, Chanez P. Neutrophils in chronic inflammatory airway diseases: can we target them and how? Eur Respir J. 2010 Mar;35(3):467–9.
6. Linden A. Neutrophils, interleukin-17A and lung disease. Eur Respir J. 2005 Jan;25(1):159–72.
7. He X, Zhou T, Yang Y, Hong S, Zhan J, Hu Z, et al. Advanced Lung Cancer Inflammation Index, a New Prognostic Score, Predicts Outcome in Patients With Small-Cell Lung Cancer. Clin Lung Cancer. 2015 Nov;16(6):e165–71.
8. Stotz M, Gerger A, Eisner F, Szkandera J, Loibner H, L Ress A, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013 Jul;109(2):416–21.
9. Aref H, Refaat S. CRP evaluation in non-small cell lung cancer. Egypt J Chest Dis Tuberc. 2014 Jul;63(3):717–22.
10. Bagley SJ, Kothari S, Aggarwal C, Bauml JM, Alley EW, Evans TL, et al. Pretreatment neutrophil-to-lymphocyte ratio as a marker of outcomes in nivolumab-treated patients with advanced non-small-cell lung cancer. Lung Cancer Amst Neth. 2017;106:1–7.
11. Diem S, Schmid S, Krapf M, Flatz L, Born D, Jochum W, et al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer Amst Neth. 2017;111:176–81.
12. Serhan CN, Brain SD, Buckley CD, Gilroy DW, Haslett C, O’Neill LAJ, et al. Resolution of inflammation: state of the art, definitions and terms. FASEB J. 2007 Feb;21(2):325–32.
13. Ibrahim SA, Kulshrestha A, Katara GK, Beaman KD. Delayed neutrophil apoptosis is regulated by cancer associated a2 isoform vacuolar ATPase. J Immunol. 2017 May 1;198(1 Supplement):76.15-76.15.
14. Greenlee-Wacker MC. Clearance of apoptotic neutrophils and resolution of inflammation. Immunol Rev. 2016 Sep;273(1):357–70.
15. Dehle FC, Mukaro VR, Jurisevic C, Moffat D, Ahern J, Hodge G, et al. Defective Lung Macrophage Function in Lung Cancer± Chronic Obstructive Pulmonary Disease (COPD/Emphysema)-Mediated by Cancer Cell Production of PGE2? PLOS ONE. 2013 Apr 26;8(4):e61573.
16. Leliefeld PHC, Koenderman L, Pillay J. How Neutrophils Shape Adaptive Immune Responses. Front Immunol. 2015 Sep;6:471.
17. Elliott MR, Koster KM, Murphy PS. Efferocytosis signaling in the regulation of macrophage inflammatory responses. J Immunol Baltim Md 1950. 2017 Feb;198(4):1387–94.
18. Shen M, Hu P, Donskov F, Wang G, Liu Q, Du J. Tumor-Associated Neutrophils as a New Prognostic Factor in Cancer: A Systematic Review and Meta-Analysis. Coleman WB, editor. PLoS ONE. 2014 Jun 6;9(6):e98259.
19. Liang W, Ferrara N. The Complex Role of Neutrophils in Tumor Angiogenesis and Metastasis. Cancer Immunol Res. 2016 Feb;4(2):83–91.
20. Kim J, Bae J-S. Tumor-Associated Macrophages and Neutrophils in Tumor Microenvironment. Mediators Inflamm. 2016

Mithun Harold Thomas

Senior Resident, Department of Gastroenterology, Government Medical College, Kozhikode, Kerala, India

Phone number: 9809587773, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.