Focus on the Dynamics of Neutrophil-to-Lymphocyte Ratio in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Meta-Analysis and Systematic Review

Guo, Yusheng; Xiang, Dongqiao; Wan, Jiayu; Yang, Lian; Zheng, Chuansheng

doi:10.3390/cancers14215297

Cited by 25 publications

(12 citation statements)

References 81 publications

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“…The findings of this study correspond with previous studies that looked at the correlation between inflammatory markers and treatment efficacy. A meta-analysis by Guo et al studying the dynamics of NLR during ICI treatment also showed that patients with a significant upward trend of NLR did not respond to immunotherapy, while those with a downward trend were associated with better clinical and treatment outcomes (16). Similarly, Zhang et al observed a significant correlation between NLR and ORR (p = 0.003) and a lack of significance between NLR and DCR (p = 0.111) in a meta-analysis involving patients with gastric cancer treated with immunotherapy (58).…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis looked at the association of dynamic changes in NLR with survival outcomes and treatment response (16). The study concluded that lower baseline NLR and a downward trend of NLR during and post-treatment with immunotherapy were associated with longer survival and better tumor response (16). However, very few studies that were included reported on treatment response and disease control.…”

Section: Introductionmentioning

confidence: 99%

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Neutrophil–lymphocyte ratio and platelet–lymphocyte ratio as potential predictive markers of treatment response in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis

Rugambwa,

Abdihamid,

Zhang

et al. 2023

Front. Oncol.

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BackgroundThe role of platelet–lymphocyte ratio (PLR) and neutrophil–lymphocyte ratio (NLR) as independent prognostic markers in different tumors is well established. However, there is a limited review of the potential of NLR and PLR as predictors of treatment outcomes from immune checkpoint inhibitors (ICIs).ObjectiveTo establish a correlation between NLR and PLR and the potential of clinical benefit from ICIs.MethodsThe literature search was performed for studies that reported the association between NLR, PLR, and treatment outcomes among cancer patients treated with ICIs. The outcomes of interest were objective response rate (ORR), disease control rate (DCR), and progressive disease (PD). ORR was the summation of patients who achieved complete response and partial response. DCR included patients who achieved stable disease. PD was the proportion of patients who progressed, relapsed, or discontinued the treatment. Statistical analysis was performed using the STATA 12.0 package. Heterogeneity was determined by the I2 value. Quality assessment was performed using the Newcastle–Ottawa Scale. Egger’s test was used to establish publication bias and sensitivity analysis.ResultsA total of 40 papers that met the inclusion criteria were included in the systematic review. However, only 17 studies were used in the meta-analysis to determine the correlation between NLR, PLR, and treatment response. We found that treatment with ICIs and monitoring of outcomes and adverse events using PLR and NLR parameters have been studied in different tumors. Our analysis showed that low NLR correlated with higher ORR (OR = 0.62 (95% CI 0.47–0.81, p = 0.001) and higher DCR (OR = 0.23, 95% CI 0.14–0.36, p < 0.001). Higher NLR predicted a higher probability of PD (OR = 3.12, 95% CI 1.44, 6.77, p = 0.004). Similarly, low PLR correlated with higher ORR (OR = 0.69, 95% CI 0.5, 0.95, p = 0.025). Generally, patients with low NLR and PLR were more likely to achieve clinical benefit and better response (p-value < 0.001). Meanwhile, patients with high ratios were more likely to progress (p-value < 0.005), although there was significant heterogeneity among studies. There was no significant publication bias observed.ConclusionThe study showed that high NLR and PLR either at baseline or during treatment is associated with poorer treatment outcome. Therefore, these ratios can be utilized in clinical practice with other markers to determine treatment efficacy from immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neutrophil–lymphocyte ratio and platelet–lymphocyte ratio as potential predictive markers of treatment response in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis

Rugambwa,

Abdihamid,

Zhang

et al. 2023

Front. Oncol.

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“…Peripheral blood markers serve as convenient and low-cost indicators of systemic immune status. Post-treatment low levels of SII and NLR have been found to be associated with treatment response in various malignancies 29 – 33 , though different cut-off values were applied for lack of standards. Here we report that a low level of SII+NLR following preoperative treatment serves as an independent predictor of pCR (Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

Association of systemic inflammatory markers and tertiary lymphoid structure with pathological complete response in gastric cancer patients receiving preoperative treatment: a retrospective cohort study

Wu,

Zhao,

Wang

et al. 2023

International Journal of Surgery

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Background: Assessment of systemic and local immune responses is crucial in determining the efficacy of cancer interventions. The identification of specific factors that correlate with pathological complete response (pCR) is essential for optimizing treatment decisions. Methods: In this retrospective study, a total of 521 patients diagnosed with gastric adenocarcinoma who underwent curative gastrectomy following preoperative treatment were reviewed. Of these patients, 463 did not achieve pCR (non-pCR) and 58 achieved pCR. Clinicopathological factors were evaluated to identify predictors for pCR using a logistic regression model. Additionally, a smaller cohort (n=76) was derived using propensity score matching to investigate local immune response, specifically the features of tertiary lymphoid structure (TLS) using H&E staining, immunohistochemistry, and multiplex immunofluorescence. Results: The multivariate regression analysis demonstrated a significant association between low systemic inflammatory status and pCR, as evidenced by reduced levels of the combined systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) (SII+NLR) (odds ratio: 3.33, 95% CI: 1.79–6.17, P<0.001). In the smaller cohort analysis, distinct TLS characteristics were correlated with the presence of pCR. Specifically, a higher density of TLS and a lower proportion of PD1+ cells and CD8+ cells within TLS in the tumor bed were strongly associated with pCR. Conclusion: Both systemic and local immune profile were associated with pCR. A low level of SII+NLR served as an independent predictor of pCR, while distinct TLS features were associated with the presence of pCR. Focusing on the immune profile was crucial for optimal management of gastric cancer patients receiving preoperative treatment.

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“…Moreover, in recent studies, a high neutrophil count and low lymphocyte count correlated with poor survival outcomes. 50 , 55 Although several studies have shown that changes in the NL ratio before and after treatment initiation could be used to assess treatment efficacy, 56 we evaluated the NL ratio at the start of treatment but did not examine dynamic changes in the NL ratio after treatment initiation. Various cutoff values for the NL ratio along with the types of immunotherapies, PFS, and OS are summarized in Table S 1 .…”

Section: Discussionmentioning

confidence: 99%

Using the neutrophil‐to‐lymphocyte ratio to predict the outcome of individuals with nonsquamous non‐small cell lung cancer receiving pembrolizumab plus platinum and pemetrexed

et al. 2023

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BackgroundFactors predicting the response to pembrolizumab plus platinum and pemetrexed combination therapy (Pemb‐Plt‐PEM) in nonsquamous non‐small cell lung cancer (non‐sq NSCLC) are unclear. We investigated the Glasgow Prognostic (GP) score, neutrophil‐to‐lymphocyte ratio (NLR), and body mass index (BMI) as predictors of response to initial treatment with combination therapy in individuals with advanced non‐sq NSCLC.MethodsWe retrospectively reviewed 236 patients who received initial treatment with combination therapy for non‐sq NSCLC at 13 institutions between December 2018 and December 2020. The usefulness of the GP score, NLR, and BMI as prognostic indicators was assessed. Cox proportional hazard models and the Kaplan–Meier method were used to compare progression‐free survival (PFS) and overall survival (OS).ResultsThe response rate was 51.2% (95% CI: 44.9–57.5%). The median PFS and OS after beginning Pemb‐Plt‐PEM were 8.8 (95% CI: 7.0–11.9) months and 23.6 (95% CI: 18.7–28.6) months, respectively. The NLR independently predicted the efficacy of Pemb‐Plt‐PEM—the PFS and OS were more prolonged in individuals with NLR <5 than in those with NLR ≥5 (PFS: 12.8 vs. 5.3 months, p = 0.0002; OS: 29.4 vs. 12.0 months, p < 0.0001). BMI predicted the treatment response—individuals with BMI ≥22.0 kg/m2 had longer OS than did those with BMI < 22.0 kg/m2 (OS: 28.4 vs. 18.4 months, p = 0.0086).ConclusionsThe NLR significantly predicted PFS and OS, whereas BMI predicted OS, in individuals who initially received Pemb‐Plt‐PEM for non‐sq NSCLC. These factors might be prognosis predictors in non‐sq NSCLC.

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Focus on the Dynamics of Neutrophil-to-Lymphocyte Ratio in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Meta-Analysis and Systematic Review

Cited by 25 publications

References 81 publications

Neutrophil–lymphocyte ratio and platelet–lymphocyte ratio as potential predictive markers of treatment response in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis

Neutrophil–lymphocyte ratio and platelet–lymphocyte ratio as potential predictive markers of treatment response in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis

Association of systemic inflammatory markers and tertiary lymphoid structure with pathological complete response in gastric cancer patients receiving preoperative treatment: a retrospective cohort study

Using the neutrophil‐to‐lymphocyte ratio to predict the outcome of individuals with nonsquamous non‐small cell lung cancer receiving pembrolizumab plus platinum and pemetrexed

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