Prognostic value of neutrophil to lymphocyte ratio in gastric cancer patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis

Abstract

BackgroundThe neutrophil to lymphocyte ratio (NLR) is a cost-effective and easily identifiable inflammatory biomarker that has been shown to be closely associated with tumor prognosis and predict survival in patients with multiple malignancies. However, the predictive value of NLR in patients with gastric cancer (GC) treated with immune checkpoint inhibitors (ICIs) has not been fully explored. Therefore, we conducted a meta-analysis to explore the potential of NLR as a predictor of survival in this population.MethodsWe systematically searched the PubMed, Cochrane Library, and EMBASE databases from inception to the present for observational researches on NLR and its relationship with progression or survival in GC patients receiving ICIs. To assess the prognostic significance of NLR on overall survival (OS) or progression-free survival (PFS), we used fixed or random-effect models to derive and combine hazard ratios (HRs) with 95% confidence intervals (CIs). We also examined the relationship between NLR and treatment efficacy by calculating relative risks (RRs) with 95% CIs for objective response rate (ORR) and disease control rate (DCR) in patients with GC receiving ICIs.ResultsNine studies of 806 patients were eligible. OS and PFS data were obtained from 9 and 5 studies, respectively. In nine studies, NLR was associated with poor survival, the pooled HR was 1.98 (95% CI 1.67- 2.35, p < 0.001), indicating a significant association between high NLR and worse OS. We conducted subgroup analyses based on study characteristics to confirm the robustness of our findings. A relationship between NLR and PFS were reported in five studies with a HR of 1.49 (95% CI 0.99- 2.23, p = 0.056), which was not significantly associated. Pooling four studies that examined the correlation between NLR and ORR/DCR in GC patients, we observed a significant correlation between NLR and ORR (RR = 0.51, p = 0.003), but no significant correlation between NLR and DCR (RR = 0.48, p = 0.111).ConclusionIn summary, this meta-analysis indicates that increased NLR is significantly linked to worse OS in patients with GC receiving ICIs. In addition, lowering NLR can improve ORR. Thus, NLR can serve as a predictor for prognosis and treatment response in GC patients treated with ICIs. Nevertheless, further high-quality prospective studies are required to verify our findings in the future.

Neutrophil–lymphocyte ratio and platelet–lymphocyte ratio as potential predictive markers of treatment response in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis

“…A meta-analysis by Guo et al studying the dynamics of NLR during ICI treatment also showed that patients with a significant upward trend of NLR did not respond to immunotherapy, while those with a downward trend were associated with better clinical and treatment outcomes (16). Similarly, Zhang et al observed a significant correlation between NLR and ORR (p = 0.003) and a lack of significance between NLR and DCR (p = 0.111) in a meta-analysis involving patients with gastric cancer treated with immunotherapy (58).…”

“…There is a paucity of literature that reported the association of NLR, PLR, and racial background in cancer patients treated with immune checkpoint inhibitors, while some studies that performed sub-group analysis according to country of origin reported contradicting results (58,83,84). However, sub-group analysis was not performed in this particular systematic review.…”

Clinical Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Acute Unilateral Vestibulopathy

“… 21 Since neutrophils are one of the first responders to acute inflammation, NLR has been proposed as a prognostic predictor as well as an inflammatory marker in many diseases such as stroke, coronary artery disease, and various kinds of cancer. 6 7 8 22 Several studies have found high NLR and PLR values to be associated with a worse prognosis in neuro-otological diseases including Bell’s palsy and sudden sensorineural hearing loss. 23 24 25 Although NLR has been considered an inflammatory biomarker in peripheral vertigo, the usefulness of this parameter as a prognostic predictor remains inconclusive in AUV.…”

“…They have been identified as useful biomarkers for assessing the inflammatory response and for predicting the prognosis of various diseases such as stroke and various kinds of cancer. 6 7 8 Likewise, both NLR and PLR have been considered inflammatory biomarkers in patients with vestibulopathies such as benign paroxysmal positional vertigo and Meniere’s disease. 9 10 11 Previous studies have also investigated the role of NLR and PLR in AUV to determine its pathogenesis, but the results were inconsistent.…”

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as biomarkers to prognosticate survival in advanced gastric cancer patients in the era of immunotherapy: a systematic review and meta-analysis

“…Our study comes in light of two previous meta-analyses that investigated the prognostic role of NLR in our target population. In their meta-analysis of nine studies, Zhang et al ( 52 ) found a significantly poorer OS for patients with high NLR but failed to find a significant relationship between high NLR and poor PFS. Within a short period of time after this study was published, Li et al ( 53 ) published another meta-analysis investigating the same group of patients in 10 studies.…”