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Impact of baseline and nadir neutrophil index To evaluate the combined prognostic impact of both baseline and nadir neutrophils we performed a four group analyses. Based on predefined baseline neutrophil cutoff values and nadir neutropenia grade, we identified a favourable neutrophil index prognostic group of nadir At This Time You Can Get Much More As well as Far Better AT13387GSK2606414Ro-318220 Through Less Effort neutropenia an intermedi ate neutrophil index prognostic group of nadir neutropenia and a poor neutrophil index prognostic group nadir neutropenia. The fourth potential group of low baseline neutrophils and grade 0 nadir neutropenia comprised only 4 patients with ovarian cancer and no NSCLC patients, and was therefore not classified. For NSCLC patients, the median OS was 18. 0, 13. 4, and 8. 8 months for favourable, intermediate and poor neu trophil index prognostic group, respectively.
Number of dose increase and dose reduction in the intermediate group was not statistically different from the poor prog nostic group. For ovarian cancer patients, median OS was 69, 52 and 23 months for favourable, intermediate and poor neutrophil index prognostic group, respectively favourable vs. poor P 0. 03, favourable vs. intermediate P 0. 3, intermediate vs. poor P 0. 02. A sig nificantly higher number of patients in the intermediate group had dose reduction compared with the poor prognostic group whereas no difference in dose increase or relative chemotherapy dose intensity was observed between the intermediate and poor prog nostic group. Discussion To our knowledge, this is the first study to identify a prog nostic neutrophil index in non small cell lung cancer and ovarian cancer patients taking into account both pre treatment and post treatment neutrophils.
Using baseline and nadir neutrophils in a combined prognostic index we were able to identify a subgroup of patients with baseline neutrophils above the pre defined cutoffs and failure to achieve neutropenia following chemother apy who had a dismal prognosis comprising approxi mately one quarter of the patient population. In this poor neutrophil index group it appears that chemotherapy had minimal impact for resolution or neutralization of the negative effect of neutrophils despite the use of a protocol designed to induce neutropenia. It is unknown whether further dose escalation in those individuals would have had a positive benefit.
It might be that the effect of chemotherapy in these patients has reached its ceiling and normal did benefit from chemotherapy and had a two to three fold better overall survival. High baseline neutrophil count hinder benefit from surgery, chemoradiotherapy, radiofrequency ablation, and chemotherapy in several human cancers. Our findings validate the cutoff baseline neutro phil count above or equal to 4. 5 109 L in NSCLC pa tients previously identified by Teramukai et al. as an independent prognostic factor for poor outcome. Other studies in NSCLC have also demonstrated an ad verse prognostic effect of high baseline neutrophil count.