Study Design
A systematic review and meta-analysis were conducted to examine the association between neutrophil-to-lymphocyte ratio (NLR) and overall survival (primary outcome), cancer-specific survival, progression-free survival, and disease-free survival (secondary outcomes). The meta-analysis included 100 studies with a total of 40,559 cancer patients.
Results
A NLR of greater than 4 was associated with statistically poorer survival in all disease subgroups, sites, and stages. The hazard ratio (HR) for overall survival was 1.81 (95% CI:1.67-1.97; P<.001). HRs for NLR greater than 4 were 1.61 for cancer-specific survival, 1.63 for progression-free survival, and 2.27 for disease-free survival (all P<.001).
Weakness
The main weakness of the meta-analysis is that the majority of studies included were retrospective.
Practice Implications
Cancer is an inflammatory process, and systemic inflammation has been shown to predict cancer-related mortality.1,2 Oncology professionals have been looking for a low-cost, reliable marker of inflammation to evaluate patient prognosis. NLR is an inflammation-based score that has emerged as a good candidate. NLR is cost effective, readily available as part of routine testing, and predictive of mortality both preoperatively and postoperatively.3 NLR also provides valuable information about the status of the immune system.
https://www.naturalmedicinejournal.com/ ... tio-cancer
Prognostic Role of Neutrophil-to-lymphocyte Ratio in Cancer
High pretreatment neutrophil-to-lymphocyte ratio (NLR) and its reactive increase as better predictors of poor clinical o
High pretreatment neutrophil-to-lymphocyte ratio (NLR) and its reactive increase as better predictors of poor clinical outcomes compared to tumor mutation burden (TMB) in solid tumor patients treated with immune checkpoint inhibitors (ICI).
Research Funding:
Background:
High NLR predicts resistance to ICIs in solid tumors. Neutrophil recruitment to tumor-draining lymph nodes post immunotherapy can exhaust cytotoxic T cells, thus promoting immunotherapy resistance. We combined NLR and DNLR [Delta NLR = NLR after first cycle - pretreatment NLR] to reflect reactive neutrophil recruitment in the peripheral blood.
Methods:
We identified 93 patients (pts) with solid tumors who received ICIs. There were 60 NSCLC, 10 melanoma, 4 RCC, and 19 other solid tumors. 49 pts received nivolumab, 27 pembrolizumab, 10 atezolizumab, and 7 ipilimumab and nivolumab. All 93 patients were categorized into three groups: good- DNLR < 0 AND NLR < 5, intermediate- DNLR < 0 OR NLR < 5, poor- DNLR≥0 AND NLR≥5. We also classified the pts according to their TMB: high [≥ 20 m/Mb (mutations per megabase)], intermediate (6-19 m/Mb) and low (≤5 m/Mb). We evaluated the overall survival (OS) and progression free survival (PFS).
https://meetinglibrary.asco.org/record/164807/abstract
Research Funding:
Background:
High NLR predicts resistance to ICIs in solid tumors. Neutrophil recruitment to tumor-draining lymph nodes post immunotherapy can exhaust cytotoxic T cells, thus promoting immunotherapy resistance. We combined NLR and DNLR [Delta NLR = NLR after first cycle - pretreatment NLR] to reflect reactive neutrophil recruitment in the peripheral blood.
Methods:
We identified 93 patients (pts) with solid tumors who received ICIs. There were 60 NSCLC, 10 melanoma, 4 RCC, and 19 other solid tumors. 49 pts received nivolumab, 27 pembrolizumab, 10 atezolizumab, and 7 ipilimumab and nivolumab. All 93 patients were categorized into three groups: good- DNLR < 0 AND NLR < 5, intermediate- DNLR < 0 OR NLR < 5, poor- DNLR≥0 AND NLR≥5. We also classified the pts according to their TMB: high [≥ 20 m/Mb (mutations per megabase)], intermediate (6-19 m/Mb) and low (≤5 m/Mb). We evaluated the overall survival (OS) and progression free survival (PFS).
https://meetinglibrary.asco.org/record/164807/abstract
Last edited by D.ap on Fri Dec 13, 2019 7:03 pm, edited 2 times in total.
Debbie
High pretreatment neutrophil-to-lymphocyte ratio (NLR) and its reactive increase as better predictors of poor clinical o
High pretreatment neutrophil-to-lymphocyte ratio (NLR) and its reactive increase as better predictors of poor clinical outcomes compared to tumor mutation burden (TMB) in solid tumor patients treated with immune checkpoint inhibitors (ICI).
Results:
The median follow-up was 15.8 months (M) (95% CI:14.0-17.6). The number of patients for good, intermediate, and poor groups were 16 (17.2%), 58 (62.3%), and 19 (20.4%) patients, respectively. The median OS for the good, intermediate, and poor groups were 23.9 (18.3-29.6), 19.7 (16.1-23.2), and 6.9 (3.6-10.2) M, respectively. Log-rank test for OS was significant (p = 0.00003). The median OS for the good group was not reached. The median OS for the intermediate, and low group were 16.7 (8.8-24.5), and 5.7 (2.6-8.8) M, respectively. We identified 11, 42 and 40 patients with high, intermediate and low TMB. There were no differences of PFS (p = 0.281) or OS (p = 0.619) across all three TMB groups.
Conclusions:
In this retrospective single institutional cohort, TMB did not correlate with clinical outcomes in this diverse and heterogenous group of solid tumor patients treated with ICIs. The combination of NLR and DNLR was a better predictor of OS regardless of the tumor types. This suggests that recruitment of reactive neutrophils may be potentially used as an indicator of poorer prognosis in patients treated with ICIs.
https://meetinglibrary.asco.org/record/164807/abstract
Results:
The median follow-up was 15.8 months (M) (95% CI:14.0-17.6). The number of patients for good, intermediate, and poor groups were 16 (17.2%), 58 (62.3%), and 19 (20.4%) patients, respectively. The median OS for the good, intermediate, and poor groups were 23.9 (18.3-29.6), 19.7 (16.1-23.2), and 6.9 (3.6-10.2) M, respectively. Log-rank test for OS was significant (p = 0.00003). The median OS for the good group was not reached. The median OS for the intermediate, and low group were 16.7 (8.8-24.5), and 5.7 (2.6-8.8) M, respectively. We identified 11, 42 and 40 patients with high, intermediate and low TMB. There were no differences of PFS (p = 0.281) or OS (p = 0.619) across all three TMB groups.
Conclusions:
In this retrospective single institutional cohort, TMB did not correlate with clinical outcomes in this diverse and heterogenous group of solid tumor patients treated with ICIs. The combination of NLR and DNLR was a better predictor of OS regardless of the tumor types. This suggests that recruitment of reactive neutrophils may be potentially used as an indicator of poorer prognosis in patients treated with ICIs.
https://meetinglibrary.asco.org/record/164807/abstract
Debbie