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Association between the Neutrophil-to-High-Density Lipoprotein Cholesterol Ratio (NHR) and all-cause mortality in patients with Stage III unresectable non-small cell lung cancer

internal-medicine
oncology
respiratory-medicine
metabolic-sciences

Abstract

Objective: This study aims to evaluate the prognostic significance of the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) in patients with stage III unresectable non-small cell lung cancer (NSCLC).

Methods: This retrospective cohort study analyzed 160 consecutive patients with stage III unresectable NSCLC who were treated at the Affiliated Hospital of Jiaxing University between January 2018 and December 2021. Participants were stratified into quartiles (Q1–Q4) based on their baseline NHR levels. Multivariable Cox proportional hazards regression models were employed to evaluate the relationship between NHR and all-cause mortality. Dose-response relationships were evaluated using restricted cubic splines, and subgroup analyses were performed according to clinical characteristics.

Results: Multivariable analysis revealed a significant increase in mortality risk across ascending NHR quartiles (adjusted P for trend = 0.003). Compared to the lowest quartile (Q1), the highest quartile (Q4) was independently associated with an increased risk of mortality (adjusted hazard ratio [HR] = 2.76, 95% confidence interval [CI] 1.33–5.73; P = 0.006) and significantly shorter median overall survival (12.0 months versus 25.5 months; P < 0.001). Kaplan–Meier survival curves confirmed progressively reduced survival in higher NHR groups (log-rank P < 0.001). Restricted cubic spline analysis revealed a linear, positive dose–response relationship between continuous NHR values and mortality risk (P for non-linearity >0.05).

Conclusions: NHR is a readily available, independent biomarker that can be used to predict all-cause mortality and optimize risk stratification in patients with stage III unresectable disease.

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