Systemic inflammation and aggressive clinical behavior in small cell lung cancer

Güzide Tomas; Mustafa Düger; Oğuz Bilgi; Şeyma Başlılar

Systemic inflammation and aggressive clinical behavior in small cell lung cancer

Abstract

Aims: Small cell lung cancer (SCLC) is characterized by rapid progression, early metastasis, and poor survival outcomes. While its aggressive behavior has traditionally been attributed to near universal genetic alterations, emerging evidence suggests that systemic inflammation and tumor host immune interactions may play a critical role in shaping disease aggressiveness. However, the prognostic significance of multiple inflammation-based biomarkers beyond established clinical factors remains incompletely defined. Methods: In this retrospective cohort study, 104 patients with histologically confirmed SCLC treated between January 2016 and December 2024 were analyzed. Baseline systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), Systemic Immune-inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and hemoglobin to red cell distribution width ratio (HGB/RDW), were calculated from peripheral blood samples obtained at diagnosis. Overall survival (OS) and disease-specific survival (DSS) were evaluated using Kaplan Meier analysis and Cox proportional hazards regression models. Multivariable analyses were performed using a clinical base model incorporating age, disease stage, ECOG performance status, and chemotherapy exposure, with inflammatory markers added individually. Results: During follow-up, 67 patients (64.4%) died. In univariate analyses, older age, lack of chemotherapy, and all inflammation based biomarkers were significantly associated with worse OS and DSS. In multivariable analyses, age and chemotherapy status remained independent predictors of OS. When added individually to the clinical base model, higher SII, SIRI, NLR, PLR, and MLR were independently associated with increased risks of both overall and disease-specific mortality, whereas higher HGB/RDW ratios were associated with improved survival. Kaplan Meier analyses demonstrated significantly poorer OS and DSS in patients with high NLR values compared with those with low NLR (log-rank p<0.001 for both). Conclusions: Multiple inflammation-based biomarkers were significantly associated with both OS and DSS in patients with SCLC. These associations remained evident after adjustment for established clinical prognostic factors, suggesting that systemic inflammation may provide additional prognostic information beyond conventional clinical variables. The consistent associations observed across several inflammatory indices support their potential utility in risk stratification. Further prospective studies are warranted to validate these findings and clarify the biological mechanisms underlying these associations.

Keywords

Supporting Institution

No supporting institution

Ethical Statement

Ethical approval Date: January 9, 2026; Approval Number: E-10840098-202.3.02-164). Given the retrospective design and the use of anonymized data, the requirement for informed consent was waived. The study was conducted in accordance with the principles of the Declaration of Helsinki.

References

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Details

Primary Language

English

Subjects

Respiratory Diseases

Journal Section

Research Article

Authors

Güzide Tomas ^*
0009-0007-8739-7969
Türkiye

Mustafa Düger
0000-0002-4091-6465
Türkiye

Oğuz Bilgi
0000-0003-1493-4579
Türkiye

Şeyma Başlılar
0000-0003-1495-6508
Türkiye

Publication Date

July 16, 2026

Submission Date

May 11, 2026

Acceptance Date

July 12, 2026

Published in Issue

Year 2026 Volume: 8 Number: 4

IZ

https://izlik.org/JA86MB55XF

Cite

RIS / Bibtex

APA

Tomas, G., Düger, M., Bilgi, O., & Başlılar, Ş. (2026). Systemic inflammation and aggressive clinical behavior in small cell lung cancer. Anatolian Current Medical Journal, 8(4), 811-817. https://izlik.org/JA86MB55XF

AMA

1.Tomas G, Düger M, Bilgi O, Başlılar Ş. Systemic inflammation and aggressive clinical behavior in small cell lung cancer. Anatolian Curr Med J / ACMJ / acmj. 2026;8(4):811-817. https://izlik.org/JA86MB55XF

Chicago

Tomas, Güzide, Mustafa Düger, Oğuz Bilgi, and Şeyma Başlılar. 2026. “Systemic Inflammation and Aggressive Clinical Behavior in Small Cell Lung Cancer”. Anatolian Current Medical Journal 8 (4): 811-17. https://izlik.org/JA86MB55XF.

EndNote

Tomas G, Düger M, Bilgi O, Başlılar Ş (July 1, 2026) Systemic inflammation and aggressive clinical behavior in small cell lung cancer. Anatolian Current Medical Journal 8 4 811–817.

IEEE

[1]G. Tomas, M. Düger, O. Bilgi, and Ş. Başlılar, “Systemic inflammation and aggressive clinical behavior in small cell lung cancer”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 4, pp. 811–817, July 2026, [Online]. Available: https://izlik.org/JA86MB55XF

ISNAD

Tomas, Güzide - Düger, Mustafa - Bilgi, Oğuz - Başlılar, Şeyma. “Systemic Inflammation and Aggressive Clinical Behavior in Small Cell Lung Cancer”. Anatolian Current Medical Journal 8/4 (July 1, 2026): 811-817. https://izlik.org/JA86MB55XF.

JAMA

1.Tomas G, Düger M, Bilgi O, Başlılar Ş. Systemic inflammation and aggressive clinical behavior in small cell lung cancer. Anatolian Curr Med J / ACMJ / acmj. 2026;8:811–817.

MLA

Tomas, Güzide, et al. “Systemic Inflammation and Aggressive Clinical Behavior in Small Cell Lung Cancer”. Anatolian Current Medical Journal, vol. 8, no. 4, July 2026, pp. 811-7, https://izlik.org/JA86MB55XF.

Vancouver

1.Güzide Tomas, Mustafa Düger, Oğuz Bilgi, Şeyma Başlılar. Systemic inflammation and aggressive clinical behavior in small cell lung cancer. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 Jul. 1;8(4):811-7. Available from: https://izlik.org/JA86MB55XF