Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Their Variations as a Basis for a Prediction Model in Advanced NSCLC Patients Receiving Anlotinib

Abstract

Background. A phase III randomized multicenter trial (ALTER0303) reported anlotinib to be significantly beneficial to patient survival. An array of inflammatory biomarkers, such as neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), are associated with the response to treatment in numerous types of cancer. However, we found few studies investigating the predictive value of NLR or PLR in advanced NSCLC treatment with anlotinib. Thus, our objective was to examine the relationship between NLR and PLR and treatment effect, as well as to individuate patient stratification and selection. Methods. NLR and PLR as well as their variations were calculated in 152 advanced NSCLC patients receiving anlotinib as a third or further-line treatment at Ningbo Medical Center Lihuili Hospital between July 2018 and December 2020. The best cut-off values of NLR and PLR for predicting the treatment response were selected. Survival curves were plotted using the Kaplan–Meier method, while univariable and multivariable Cox regression were used to identify and determine dependent and independent predictors of survival. Results, Low disease control rate (DCR) was related with a high pre-NLR ( P = 0.007 ), high pre-PLR ( P = 0.004 ), and elevated post-NLR ( P = 0.010 ). Multivariate analysis determined high pre-PLR (>205.63) and elevated post-NLR to be independently associated with poor PFS or OS. Patients whose risk score was 2 resulting from the prediction model based on pre-PLR and post-NLR had a 4.52 times higher risk of death compared to patients whose risk score was 0 (HR: 4.516, 95% CI: 2.502-8.152, P ≤ 0.001 ). Conclusions. Pre-PLR and post-NLR were independent prognostic indicators in patients with advanced NSCLC receiving anlotinib as a third or further-line treatment. Patients whose risk value score was 0 had a higher therapy effectiveness and better survival.

Inflammation‐based prognostic scoring system for predicting the prognosis of advanced small cell lung cancer patients receiving anlotinib monotherapy

“…Recently, three retrospective studies about SCLC treatment with anlotinib had tried to select some ways to identify those benefit patients, which indicated that the response to first‐line treatment, 22 prognostic nutritional indexes, 11 and tumor cavitation 9 could predict survival independently, yet all through relatively simple means. Our team once established a system of risk scores by different combinations of multiple inflammatory indicators in NSCLC, which was capable of predicting the best population for anlotinib treatment 7 . Therefore, this study was focused on developing a prognostic scoring system in SCLC that included NLR, PLR, and LMR and successfully selecting the dominant population, which was bound to be more comprehensive than a single prognostic factor as previously described.…”

“… 10 Although we found similar results in this study but did not share the same cut‐off value, which is 240.56 in SCLC and 205.63 in NSCLC, the conclusion from our previous study about NSCLC patients receiving anlotinib indicated that high pre‐PLR was related to poor outcome. 7 This phenomenon revealed the existence of different tumors with different cutoff values and the possibility of the difference being caused by insufficient sample capacity. In order to improve the predictive ability of the anlotinib drug, we set up an inflammatory‐based prognostic score system according to the independent prognostic factors from our research (post‐NLR elevation, pre‐PLR > 240.56, and pre‐LMR ≤1.61).…”

“…Our team once established a system of risk scores by different combinations of multiple inflammatory indicators in NSCLC, which was capable of predicting the best population for anlotinib treatment. 7 Therefore, this study was focused on developing a prognostic scoring system in SCLC that included NLR, PLR, and LMR and successfully selecting the dominant population, which was bound to be more comprehensive than a single prognostic factor as previously described. The inflammation‐based prognostic scoring system revealed favorable predictive ability from the ROC curve (AUC: 0.791) (Figure 7 ).…”

“… 13 , 14 , 15 , 16 , 17 Recently, some studies exhibited the predictive function of inflammatory markers, including NLR and PLR, in different cancers treated with different anti‐vascular targeting drugs. 7 , 18 , 19 , 20 An inflammatory biomarker called LMR was discovered to act with potential predictive value in SCLC. 21 However, no studies have described the predictive value of NLR, PLR, or LMR in SCLC patients receiving anlotinib therapy.…”

Lower Platelet-to-Lymphocyte Ratio Was Associated with Poor Prognosis for Newborn Patients in NICU

“…In recent years, the neutrophil-to-lymphocyte ratio (NLR), [ 5 ] lymphocyte-to-monocyte ratio (LMR) [ 6 ] and platelet-to-lymphocyte ratio (PLR) [ 7 ] have been found to be independent predictors of prognosis in various benign and malignant conditions [ 8 , 9 , 10 , 11 ]. Moreover, NLR, LMR and PLR were reported to be related to the outcome of intensive care unit (ICU) patients, because of their rapid response to systemic inflammation and stress [ 12 , 13 , 14 ].…”