Impact of the Neutrophil-to-Lymphocyte Ratio on the Survival of Patients with Gastric Cancer Treated with Nivolumab Monotherapy

Yamada, Takanobu; Hayashi, Tsutomu; Inokuchi, Yasuhiro; Hayashi, Kimihiro; Watanabe, Hayato; Komori, Keisuke; Kano, Kazuki; Shimoda, Yota; Fujikawa, Hirohito; Shiozawa, Manabu; Morinaga, Soichiro; Rino, Yasushi; Masuda, Munetaka; Ogata, Takashi; Oshima, Takashi

doi:10.1007/s11523-020-00716-y

Cited by 21 publications

(23 citation statements)

References 32 publications

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“…A meta-analysis including 738 ICI-treated patients with NSCLC or melanoma or advanced GU cancer showed that a high NLR was associated with poorer outcomes [ 34 ]. Currently, only two studies focused on NLR changes after Nivolumab monotherapy or baseline NLR prior to Nivolumab for gastric cancer in the third or further lines [ 26 , 28 ]. Several trials had shown that Nivolumab combined with chemotherapy was superior to chemotherapy alone in the first line concerning PFS and OS [ 9 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

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Neutrophil-to-Lymphocyte Ratio (NLR) Predicts PD-1 Inhibitor Survival in Patients with Metastatic Gastric Cancer

Gou

Wang

et al. 2021

Journal of Immunology Research

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Background and Aims. Biomarkers for systemic inflammation have been introduced into clinical practice for risk-rating in cancer patients’ treatment. This study is aimed at confirming the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) as an effective biomarker for patients with metastatic gastric cancer (MGC) receiving anti-PD-1 agents. Method. Patients with MGC who received anti-PD-1 treatment at the Chinese PLA General Hospital between January 2016 and November 2020 were reviewed. The study analyzed the association of NLR and overall survival (OS) or progression-free survival (PFS) and antitumor response rate with PD-1 inhibitors. Results. 137 patients were included in the final analysis. The area under the curve value of NLR for 6-month OS was 0.71. The best cut-off value for NLR was 3.23. NLR < 3.23 was associated with longer OS ( HR = 0.38 , 95% CI, 0.26-0.57, p < 0.001 ) and PFS ( HR = 0.42 , 95% CI, 0.29-0.62, p < 0.001 ) in patients with MGC. No significant difference was observed in the objective response rate (ORR) (35.8% vs. 28.6%, p = 0.377 ) and disease control rate (DCR) (86.4% vs. 78.6%, p = 0.229 ) in the NLR < 3.23 group and in the NLR ≥ 3.23 group, respectively. Univariate analysis and multivariate analysis found that NLR was an independent prognosis biomarker for PFS and OS. Conclusions. Pretreatment elevated NLR was significantly associated with inferior PFS and OS in patients with MGC who received anti-PD-1 inhibitors. Clinicians need to consider patients with elevated NLR for decisions on immunotherapy strategy.

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Section: Discussionmentioning

confidence: 99%

“…However, there was no standard for selecting the cut-off value. Some studies had applied the receiver operating characteristic (ROC) curve for estimating the cut-off value [ 21 , 26 , 28 , 45 – 47 ]. The median value of NLR was also used as the cut-off of NLR in the study [ 24 , 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio (NLR) Predicts PD-1 Inhibitor Survival in Patients with Metastatic Gastric Cancer

Gou

Wang

et al. 2021

Journal of Immunology Research

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“…Ueda et al demonstrated that the optimal cut-off value of ALC for predicting PFS was 1,300/µl and that an ALC ≥1,300/µl is an independent prognostic factor in metastatic renal cell carcinoma patients ( 28 ). In gastric cancer, Ogata et al ( 18 ) set the cut-off value for NLR in unresectable or recurrent gastric cancer at 5, whereas Yamada et al ( 17 ) set it at 2.5; therefore, the cut-off value differs among studies. The cut-off values determined in this study were all within the range of previous reports and we believe that setting the cut-off value at the median is not inappropriate.…”

Section: Discussionmentioning

confidence: 99%

Absolute lymphocyte count and C‑reactive protein‑albumin ratio can predict prognosis and adverse events in patients with recurrent esophageal cancer treated with nivolumab therapy

et al. 2022

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Predicting the prognosis and adverse events (AEs) of nivolumab therapy for recurrent esophageal cancer is very important. The present study investigated whether a simple blood biochemical examination could be used to predict prognosis and AEs following nivolumab treatment for relapse of esophageal cancer. A total of 41 patients who received nivolumab treatment for recurrent esophageal cancer after esophagectomy were analyzed. The absolute lymphocyte count (ALC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) and C-reactive protein-albumin ratio (CAR) were assessed at the time of nivolumab induction as indices that can be calculated by blood biochemical examinations alone. Median values were 1,015 for ALC, 3.401 for NLR, 242.6 for PLR, 0.458 for MLR and 0.119 for CAR, and patients were divided into two groups according to values. A high ALC, low NLR, low PLR, low MLR and low CAR were associated with a better response to nivolumab. In addition, patients with the aforementioned indices, with the exception of low PLR, or better response were more likely to develop AEs in univariate analysis. In multivariate analysis, a high ALC [odds ratio (OR): 4.857, P=0.043] and low CAR (OR: 9.099, P=0.004) were identified as independent risk factors for AEs. Survival analysis revealed that overall survival and progression-free survival (PFS) rates after nivolumab treatment differed significantly between the high and low groups of ALC, NLR, PLR, MLR and CAR. The multivariate analysis identified a low ALC [hazard ratio (HR): 3.710, P=0.003] and high CAR (HR: 2.953, P=0.007) as independent poor prognostic factors of PFS. In conclusion, ALC and CAR have potential as biomarkers for outcomes of recurrent esophageal cancer following nivolumab treatment.

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“…Several studies have evaluated the relationship between blood parameters and gastric cancer; however, most have evaluated the results of surgery, radiotherapy, and postoperative chemotherapy. 20 – 22 Thus, the relationship between PFS after therapy for AGC and blood parameters had not been fully evaluated. In this study, we developed a nomogram using laboratory markers of pre-chemotherapy hematology and systemic inflammatory response to improve prognostic prediction in patients with AGC after chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, even within a single cancer type, establishing standard cut-offs that are applicable worldwide proves challenging. 21 , 27 , 41 , 42 Second, due to the retrospective nature of this study and the lack of external validation, the prognostic relevance of the combined model in AGC patients requires prospective studies in other populations and larger cohorts. Third, blood cell counts can be affected by several factors; however, we limited some potential confounding factors.…”

Section: Discussionmentioning

confidence: 99%

A Nomogram Combining Neutrophil-to-Lymphocyte Ratio and D-Dimer Predicts Chemosensitivity of Oxaliplatin-Based First-Line Chemotherapy in Patients with Unresectable Advanced Gastric Cancer

Shen

et al. 2022

Technol Cancer Res Treat

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Introduction: No effective peripheral blood predictors have been establoshed for first-line chemotherapy in patients with advanced gastric cancer. In this study, a nomogram combining the neutrophil-to-lymphocyte ratio/D-dimer with gender, number of metastases, and histological grade was established to predict progression-free survival in patients with unresectable advanced gastric cancer. Methods: We retrospectively collected baseline clinical characteristics and blood parameters from 153 patients diagnosed with advanced gastric cancer that underwent oxaliplatin-based first-line chemotherapy. Kaplan–Meier analysis and Cox regression analysis were used to determine the factors associated with progression-free survival. The concordance index (C-index) and calibration curve were used to determine the prediction accuracy and discriminative ability of the nomogram as a visual complement to the prognostic score system. Results: Determined by the X-tile software, the optimal cut-off points for the neutrophil-to-lymphocyte ratio and D-dimer were 3.18 and 0.56 mg/L, respectively. Multivariate analysis identified four independent prognostic factors: two or more metastatic organs (HR: 1.562, 95% CI: 1.009-2.418, P = .046), poor differentiation (HR: 0.308, 95% CI: 0.194-0.487, P < .001), neutrophil-to-lymphocyte ratio >3.18 (HR: 1.427, 95% CI: 1.024-1.989, P = .036), and D-dimer >0.56 mg/L (HR: 1.811, 95% CI: 1.183-2.773, P = .006). Receiver operating characteristic curves showed that the combination of the neutrophil-to-lymphocyte ratio and D-dimer in the prediction model exhibited the highest predictive performance (area under the curve, 0.800). The prognostic nomogram yielded a C-index of 0.800. Decision curve analysis demonstrated that the prognostic nomogram was clinically useful. A nomogram-based risk classification system was also constructed to facilitate risk stratification of advanced gastric cancer for optimal clinical management. Conclusion: We identified the neutrophil-to-lymphocyte ratio and D-dimer level as independent prognostic factors for advanced gastric cancer. The prognostic nomogram combining the neutrophil-to-lymphocyte ratio and D-dimer level can be applied in the individualized prediction of treatment outcome in patients with advanced gastric cancer.

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Impact of the Neutrophil-to-Lymphocyte Ratio on the Survival of Patients with Gastric Cancer Treated with Nivolumab Monotherapy

Cited by 21 publications

References 32 publications

Neutrophil-to-Lymphocyte Ratio (NLR) Predicts PD-1 Inhibitor Survival in Patients with Metastatic Gastric Cancer

Neutrophil-to-Lymphocyte Ratio (NLR) Predicts PD-1 Inhibitor Survival in Patients with Metastatic Gastric Cancer

Absolute lymphocyte count and C‑reactive protein‑albumin ratio can predict prognosis and adverse events in patients with recurrent esophageal cancer treated with nivolumab therapy

A Nomogram Combining Neutrophil-to-Lymphocyte Ratio and D-Dimer Predicts Chemosensitivity of Oxaliplatin-Based First-Line Chemotherapy in Patients with Unresectable Advanced Gastric Cancer

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