Pretreatment Neutrophil-to-Lymphocyte Ratio and Lactate Dehydrogenase Predict the Prognosis of Metastatic Cervical Cancer Treated with Combination Immunotherapy

Abstract

Background. Immune checkpoint inhibitors have considerably changed the treatment paradigm for metastatic cervical cancer; nonetheless, only a proportion of patients achieve a durable response. Therefore, exploring the predictive biomarkers of immunotherapy response is of crucial importance. This study aimed to evaluate the predictive and prognostic value of hematological parameters in patients with metastatic cervical cancer treated with combination immunotherapy. Methods. Clinical data of patients with metastatic cervical cancer treated with combination immunotherapy between June 2019 and April 2021 were retrospectively analyzed. Receiver operating characteristic curve analysis was performed to determine the cut-off values of continuous variables, and binary logistic analysis was conducted to compare the treatment response between groups. The Kaplan–Meier method was applied for survival analysis. A Cox proportional hazards regression model was used to identify factors associated with progression-free survival (PFS). Results. Seventy patients were included in this study. The cut-off values for the neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) were 5.33 and 195.00 U/L, respectively. High pretreatment NLR (≥5.33) was correlated with decreased objective response rate (53.19% vs. 78.26%, p = 0.048 ). The survival analysis revealed that high pretreatment NLR (hazard ratio HR = 2.401 , 95% confidence interval [CI]: 1.151–5.009, p = 0.020 ) and LDH level ( HR = 1.987 , 95% CI: 1.029–3.835, p = 0.041 ) were independent prognostic factors associated with short PFS. Conclusions. Our study suggested that high pretreatment NLR and LDH values were independently correlated with poor survival in patients with metastatic cervical cancer treated with combination immunotherapy. Pretreatment NLR and LDH values could serve as potential biomarkers that may aid in the selection of patients who would benefit from combination immunotherapy. Further prospective studies investigating the prognostic value of NLR and LDH are warranted. Trial registration number: UHCT22008.

Tislelizumab for cervical cancer: A retrospective study and analysis of correlative blood biomarkers

“…We also found that the baseline CAR was a significant and independent prognostic factor for PFS and OS, as patients with elevated CAR had a short PFS and OS after tislelizumab therapy. However, the pretreatment NLR showed no significant association with the response to PD-1 inhibitors or PFS, which was in contrast to the results of a previous study ( 20 ) and warrants further investigation. Overall, pretreatment serum CRP and CAR levels may be the promising biomarkers for predicting the response to treatment and prognosis of R/M CC patients treated with PD-1 inhibitors.…”

“…Routine blood tests can indicate the state of inflammation and nutrition, which have been reported to affect the efficacy of immunotherapy ( 38 ) and have the advantages of being easily available and cost-effective. One study assessed the relationship between immunotherapy and hematological parameters, namely NLR, PLR, MLR, albumin-to-globulin ratio, alkaline phosphatase and lactate dehydrogenase (LDH) in CC patients, and found that high pretreatment NLR and LDH were independently correlated with poor survival ( 20 ). Thus, the predictive value of hematological parameters, especially those reflecting the inflammatory and nutritional status of patients with CC receiving PD-1 inhibitors, merits further study.…”

“…There is emerging evidence suggesting that several hematological parameters obtained from routine blood tests can reflect inflammation and nutritional status and thereby, play an essential role in predicting immunotherapy efficacy. Some examples of these parameters are C-reactive protein (CRP) concentration, CRP-to-albumin ratio (CAR), and neutrophil-to-lymphocyte ratio (NLR) ( 20 ). Elevated CAR and pretreatment CRP levels predict poor antitumor responses and clinical outcomes for the treatment of various malignancies with PD-1 inhibitors ( 21 – 23 ).…”

The impact of bone marrow irradiation dose on acute haematologic toxicity in cervical cancer patients treated with concurrent chemoradiotherapy

“…At present, in cervical cancer, studies have shown that an increased NLR is associated with poor prognosis of cervical cancer [ 21 , 22 ]. Cheng’s study [ 23 ] suggested that high pretreatment NLR values were independently correlated with poor survival in patients with metastatic cervical cancer treated with combination immunotherapy. Therefore, whether controlling the dose of BM irradiation and reducing the NLR can improve the prognosis of patients with cervical cancer needs further study.…”

Ability of Blood Cell Parameters to Predict Clinical Outcomes of Nivolumab Monotherapy in Advanced Esophageal Squamous Cell Carcinoma

“…Blood cell parameters such as neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios (NLRs, PLRs and LMRs, respectively) are predictive markers of therapeutic effects and survival rates among patients with various types of cancer treated with ICIs. [11][12][13][14][15][16][17][18] However, to the best of our knowledge, correlations among blood parameters, therapeutic effects and survival have not been fully evaluated in patients with ESCC under nivolumab monotherapy. Here, we evaluated the ability of various clinical factors, including NLR, PLR and LMR, to predict therapeutic effects and survival in patients with unresectable advanced or recurrent ESCC treated with second-or laterline nivolumab monotherapy.…”