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Prognostic value of neutrophil-to-lymphocyte ratio in advanced cancer patients receiving immunotherapy

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Abstract

Background

The prognostic value of neutrophil-to-lymphocyte ratio (NLR) has been extensively studied in cancer patients. However, the performance of NLR as an early marker of efficacy of immune checkpoint inhibitors (ICI) is still understudied. We studied the utility of NLR at baseline (bNLR), before the second dose of immunotherapy (NLR2) and the NLR trend for predicting efficacy outcomes.

Methods

We included all patients with advanced cancer treated with ICI from June 2013 to April 2019 at La Paz University Hospital, Madrid (Spain). We examined bNLR, NLR2 and NLR trend and explored the association with progression-free survival (PFS) at 6 months, median PFS and overall survival (OS).

Results

We included 211 patients. PFS and OS were significantly longer in the low bNLR group than in the high bNLR group [HR 0.71 (95% CI 0.60–0.84) and HR: 0.66 (95% CI 0.55–0.79), respectively]. Regarding NLR2, patients with low NLR2 had significantly longer PFS and OS than patients with high NLR2 [HR 0.67 (95% CI 0.57–0.79) and HR: 0.60 (95% CI 0.50–0.72), respectively]. Finally, for NLR trend, PFS and OS for patients with NLR trend < 1 were significantly longer than those patients with NLR trend ≥ 1 [HR 0.59 (95% CI 0.43–0.82) and HR 0.63 (95% CI 0.44–0.90), respectively]. At the multivariate analysis for PFS and OS, bNLR, NLR2 and NLR trend were all independent prognostic factors for PFS and OS.

Conclusions

bNLR, NLR2 and NLR trends are independent prognostic factors for survival in patients on immunotherapy. The dynamics of NLR in patients on immunotherapy is a promising marker that needs further investigation.

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Acknowledgements

This work has not been supported by public grants or financial support. No sources of funding were used to assist in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain

    D. Viñal, L. Gutierrez-Sainz, D. Martinez, J. A. Garcia-Cuesta, J. Pedregosa, J. Villamayor, L. Ostios, D. Sanchez-Cabrero, O. Higuera, A. Pinto, N. Rodriguez-Salas, E. Espinosa, J. de Castro & J. Feliu

  2. Translational Oncology Group, IdiPAZ, Madrid, Spain

    A. Pinto, N. Rodriguez-Salas, E. Espinosa & J. Feliu

  3. Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

    A. Pinto, N. Rodriguez-Salas, E. Espinosa, J. de Castro & J. Feliu

  4. CIBERONC, Madrid, Spain

    N. Rodriguez-Salas, E. Espinosa & J. Feliu

  5. Cátedra UAM-AMGEN, Madrid, Spain

    E. Espinosa & J. Feliu

  6. Experimental Therapies and Novel Biomarkers in Cancer IdiPAZ, Madrid, Spain

    J. de Castro

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  1. D. Viñal
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Contributions

Conceptualization: DV; data collection: DV, DM, JAG-C, LG-S, JV; Data analysis: DV, AP. Writing—original draft preparation: DV; writing—review and editing: LG-S, DM, JAG-C, JP, JV, LO, DS-C, OH, AP, NR-S, EE, JdC, JF; Supervision: EE, JdC, JF.

Corresponding author

Correspondence to D. Viñal.

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Conflict of interest

The authors declare that they have no conflict of interest. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests.

Ethical approval

This study was approved by the Ethics Committee of the La Paz University Hospital. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Local ethical committee approved the use of anonymized historic samples and data for the study and waived informed consent from patients.

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Viñal, D., Gutierrez-Sainz, L., Martinez, D. et al. Prognostic value of neutrophil-to-lymphocyte ratio in advanced cancer patients receiving immunotherapy. Clin Transl Oncol 23, 1185–1192 (2021). https://doi.org/10.1007/s12094-020-02509-1

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