Baseline neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of host inflammation and have been reported as prognostic factors in advanced cancer patients, but have not been analyzed extensively in lung cancer in the era of immunotherapy, especially the dynamic changes of these markers.
Patients who were treated with immune checkpoint inhibitors (ICIs) either as a standard of care or on a clinical trial at Shanghai Pulmonary Hospital were enrolled. Baseline complete blood count [defined as the results obtained at the time (−3/0 days) of initiating ICIs, including white blood cell (WBC), absolute neutrophil count (ANC), platelet count and absolute lymphocyte count (ALC) to calculate the NLR and PLR] were extracted from medical records. Derived NLR (dNLR) was calculated as dNLR = ANC/(WBC−ALC). C3 complete blood count (defined as the results obtained before Cycle 3 of ICIs) was also collected and calculated.
Ninety-five patients were identified in the present study. 49 (51.6%) of patients received ICI monotherapy, and 46 (48.4%) received ICI-based combination therapy. Baseline NLR, dNLR, PLR were not associated with clinical outcomes of ICI therapy (ORR or PFS). Using 5 as a C3 NLR cut-off value, patients with C3 NLR <5 had better ORR and PFS than those with C3 NLR ≥5. Furthermore, patients who had increased NLR (n = 29) had inferior ORR (17.2% versus 41.0%, P = 0.026) and median PFS (5.5 versus 8.5 months, P = 0.022) than those who had decreased NLR (n = 61). Patients with C3 dNLR <3 had better ORR and median PFS than those with C3 dNLR ≥3. Patients who had increased dNLR (n = 26) had lower ORR (15.4% versus 40.3%, P = 0.027) and inferior median PFS (5.6 versus 8.4 months, P = 0.150) than those who had decreased dNLR. There was a trend towards better ORR and median PFS in patients lower C3 PLR. Interestingly, patients who had decreased PLR (n = 47) had better ORR (42.6% versus 23.3%, P = 0.052) and median PFS (11.8 versus 5.5 months, P = 0.003) than those who had increased PLR (n = 43). Multivariate analysis revealed dynamic changes of PLR as an independent predictive factor for PFS (HR: 2.27, 95% CI, 1.10-4.71, P = 0.027).
Dynamic change of PLR has a potentially predictive role of the efficacy of ICI therapy.
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