Prognostic Performance of the Derived Neutrophil-to-Lymphocyte Ratio in Stage IV Melanoma Patients Treated with Immune Checkpoint Inhibitors

Abstract

The purpose was to evaluate the prognostic performance of the derived neutrophil–to-lymphocyte ratio (dNLR) in patients with metastatic cutaneous melanoma (CM) treated with immune checkpoint inhibitors (ICI). We retrospectively investigated 41 CM patients with stage IV disease who had the indication for treatment with ICI. dNLR as well as NLR were routinely determined prior to the start of ICI treatment. The dNLR and NLR were calculated as follows: dNLR = absolute neutrophil counts (ANC)/white blood cell count −ANC and NRL = ANC/absolute lymphocyte counts, respectively. Follow-up of the patients was performed in line with current guidelines. In univariate analysis, dNLR (p = 0.027 and p = 0.032) as well as NLR (p = 0.0023 and p = 0.0036) were the only parameters which were significantly associated with the best overall response (BOR) and disease control rate (DCR) on ROC curve analyses. NLR negatively correlated with CM-specific survival (r = −0.32, p = 0.043). CM-specific deaths were significantly associated with the absence of immune-related adverse events (p = 0.043), elevated S100 calcium-binding protein B (S100B) at baseline (p = 0.0006), and dNLR (p = 0.024). In multivariate analyses, NLR was the only significant independent predictor for BOR (p = 0.014; odds ratio: 1.7; and 95% CI 1.11 to 2.61) and DCR (p = 0.019; odds ratio: 1.5; and 95% CI 1.07 to 2.19). Regarding CM-specific death, however, normal baseline S100B was the only significant independent predictor (p = 0.0020; odds ratio: 0.074; and 95% CI 0.014 to 0.38) for survival. Our data demonstrate that baseline NLR seems to be superior to dNLR in the prediction of ICI response in CM patients.

The Utility of Pre-Treatment Inflammation Markers as Associative Factors to the Adverse Outcomes of Vulvar Cancer: A Study on Staging, Nodal Involvement, and Metastasis Models

“…Unlike NLR, multivariate analysis in this study did not reveal any proof of a connection between dNLR and staging, LNM, or DM. NLR and dNLR look identical and have similar effects on cancer-specific mortality [91,92]. Our investigation supported this hypothesis, which found a robust positive correlation between dNLR and NLR (ρ = 0.950, p < 0.001).…”

The outcome in patients with BRAF‐mutated metastatic melanoma treated with anti‐programmed death receptor‐1 monotherapy or targeted therapy in the real‐world setting

“…A survival receiver operating characteristic (ROC) analysis was adopted to identify potential cut-offs that optimally stratify patients into risk groups. Optimal thresholds for blood cell count-derived ratios were determined based on literature reviews [7][8][9][10][11][12][13] and our previous work, where we used those cut-offs and verified their applicability. 14 The cut-off values were set as follows: NLR 3, PLR 160, LMR 2, SII 800 and dNLR 1,9, respectively.…”

Prognostic Potential of the Baseline Pan-Immune-Inflammation Value and Neutrophil/Lymphocyte Ratio in Stage I to III Melanoma Patients

“…Multiple investigations have shown that an increased NLR is associated with poor clinical outcomes in many malignancies, but this parameter has not been thoroughly investigated in CM, except for stage IV, particularly in the context of the use of ICI [ 31 , 33 , 34 ]. Lino-Silva et al [ 35 ] was the first study group investigating NLR in CM stages I–III.…”