Prognostic value of neutrophil‐to‐lymphocyte ratio in gastric cancer patients treated with immune checkpoint inhibitors: A meta‐analysis

Li, Lili; Pan, Lisha

doi:10.1002/kjm2.12694

Cited by 4 publications

(4 citation statements)

References 41 publications

(151 reference statements)

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“…Moreover, additional studies have been published since their search deadlines. Our results are consistent with those of Li et al ( 53 ), with shorter P values and stricter 95% CIs for PFS analysis.…”

Section: Discussionsupporting

confidence: 93%

“…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. In this systematic review, significant associations were found between poor OS prognosis and high NLR values and between poor PFS prognosis and high NLR values.…”

Section: Discussionmentioning

confidence: 99%

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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

Matsas,

Aguiar Jr,

Del Giglio

2024

J Gastrointest Oncol

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Background Gastric cancer (GC) remains an important global health concern with limited treatment options for advanced cases. Immunotherapy has shown promising results, but identifying predictive biomarkers for treatment efficacy is challenging. Novel inflammatory markers, such as the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), derived from complete blood count measurements, have gained attention as potential prognostic indicators. This systematic review and meta-analysis investigates the roles of the PLR and NLR as predictors of overall survival (OS) and progression-free survival (PFS) in advanced GC and gastroesophageal junction cancer (GEJC) patients treated with immunotherapy. Methods A comprehensive search of the literature was conducted through PubMed, Embase, and Cochrane Library to identify relevant studies. A total of 16 studies involving NLR and 8 studies involving PLR were included. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to assess the association between high biomarker values and poor OS and PFS. Subgroup analyses were performed to explore potential sources of heterogeneity. Poor OS, PFS were defined by each study as statistically significant shorter survival. Results A high NLR was significantly associated with worse OS (HR: 2.11; 95% CI: 1.70–2.62) and PFS (HR: 1.76; 95% CI: 1.43–2.17). High PLR was also significantly associated with poorer OS (HR: 1.77; 95% CI: 1.44–2.17) and PFS (HR: 1.61; 95% CI: 1.33–1.96). Subgroup analyses and sensitivity analyses supported the robustness of these findings. Publication bias was noted in NLR analysis for OS but not for PFS. PLR analysis showed low publication bias. Conclusions Elevated NLR and PLR are associated with unfavorable OS and PFS outcomes in advanced GC/GEJC patients on immunotherapy. These findings imply the utility of these easily accessible biomarkers in prognostic assessment. However, standardized cutoff values and further research on interactions with the tumor microenvironment and comorbidities are needed. Additional prospective studies are warranted to validate these findings for both biomarkers.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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

Matsas,

Aguiar Jr,

Del Giglio

2024

J Gastrointest Oncol

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“…Systematic reviews and meta-analyses have provided evidence that high baseline neutrophil count or high NLR were independently associated with adverse overall survival in various types of solid tumors ( 84 , 117 , 118 , 145 – 151 ), while normalization of post-treatment NLR was associated with improved survival ( 84 ). Moreover, systematic reviews and/or meta-analyses examining the correlation between NLR and outcomes in patients treated with immune checkpoint inhibitors have reported that higher NLR is a prognostic factor of worse disease control rate, objective response rate, progression-free survival, and/or overall survival in patients with head and neck squamous cell carcinoma ( 152 , 153 ), gastric carcinoma ( 154 , 155 ), melanoma ( 156 ), metastatic renal cell carcinoma ( 157 , 158 ), non-small cell lung carcinoma ( 159 ), hepatocellular carcinoma ( 160 ) and cancer patients in general ( 161 – 163 ). High post-treatment NLR has also been associated with poor survival outcomes in cancer patients treated with immune checkpoint inhibitors ( 162 ).…”

Section: A High Neutrophil-to-lymphocyte Ratio Is An Independent Prog...mentioning

confidence: 99%

Systemic and local immunosuppression in glioblastoma and its prognostic significance

Stepanenko,

Sosnovtseva,

Valikhov

et al. 2024

Front. Immunol.

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The effectiveness of tumor therapy, especially immunotherapy and oncolytic virotherapy, critically depends on the activity of the host immune cells. However, various local and systemic mechanisms of immunosuppression operate in cancer patients. Tumor-associated immunosuppression involves deregulation of many components of immunity, including a decrease in the number of T lymphocytes (lymphopenia), an increase in the levels or ratios of circulating and tumor-infiltrating immunosuppressive subsets [e.g., macrophages, microglia, myeloid-derived suppressor cells (MDSCs), and regulatory T cells (Tregs)], as well as defective functions of subsets of antigen-presenting, helper and effector immune cell due to altered expression of various soluble and membrane proteins (receptors, costimulatory molecules, and cytokines). In this review, we specifically focus on data from patients with glioblastoma/glioma before standard chemoradiotherapy. We discuss glioblastoma-related immunosuppression at baseline and the prognostic significance of different subsets of circulating and tumor-infiltrating immune cells (lymphocytes, CD4+ and CD8+ T cells, Tregs, natural killer (NK) cells, neutrophils, macrophages, MDSCs, and dendritic cells), including neutrophil-to-lymphocyte ratio (NLR), focus on the immune landscape and prognostic significance of isocitrate dehydrogenase (IDH)-mutant gliomas, proneural, classical and mesenchymal molecular subtypes, and highlight the features of immune surveillance in the brain. All attempts to identify a reliable prognostic immune marker in glioblastoma tissue have led to contradictory results, which can be explained, among other things, by the unprecedented level of spatial heterogeneity of the immune infiltrate and the significant phenotypic diversity and (dys)functional states of immune subpopulations. High NLR is one of the most repeatedly confirmed independent prognostic factors for shorter overall survival in patients with glioblastoma and carcinoma, and its combination with other markers of the immune response or systemic inflammation significantly improves the accuracy of prediction; however, more prospective studies are needed to confirm the prognostic/predictive power of NLR. We call for the inclusion of dynamic assessment of NLR and other blood inflammatory markers (e.g., absolute/total lymphocyte count, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, and systemic immune response index) in all neuro-oncology studies for rigorous evaluation and comparison of their individual and combinatorial prognostic/predictive significance and relative superiority.

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“…The T-cell-related gene prognostic index is a potential prognostic indicator used to distinguish the response to immune checkpoint inhibitor (ICI) therapy ( Chen J. et al, 2023 ). The neutrophil-to-lymphocyte ratio is an effective biomarker used for evaluating the prognosis of GC patients who received ICI therapy ( Li and Pan, 2023 ). Unfortunately, only a minority of patients with GC develop durable clinical responses to CIT ( Baxter et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

A tumor-associated endothelial signature score model in immunotherapy and prognosis across pan-cancers

Chen,

Zhang,

Huang

et al. 2023

Front. Pharmacol.

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Background: The tumor-associated endothelial cell (TAE) component plays a vital role in tumor immunity. However, systematic tumor-associated endothelial-related gene assessment models for predicting cancer immunotherapy (CIT) responses and survival across human cancers have not been explored. Herein, we investigated a TAE gene risk model to predict CIT responses and patient survival in a pan-cancer analysis.Methods: We analyzed publicly available datasets of tumor samples with gene expression and clinical information, including gastric cancer, metastatic urothelial cancer, metastatic melanoma, non-small cell lung cancer, primary bladder cancer, and renal cell carcinoma. We further established a binary classification model to predict CIT responses using the least absolute shrinkage and selection operator (LASSO) computational algorithm.Results: The model demonstrated a high predictive accuracy in both training and validation cohorts. The response rate of the high score group to immunotherapy in the training cohort was significantly higher than that of the low score group, with CIT response rates of 51% and 27%, respectively. The survival analysis showed that the prognosis of the high score group was significantly better than that of the low score group (all p < 0·001). Tumor-associated endothelial gene signature scores positively correlated with immune checkpoint genes, suggesting that immune checkpoint inhibitors may benefit patients in the high score group. The analysis of TAE scores across 33 human cancers revealed that the TAE model could reflect immune cell infiltration and predict the survival of cancer patients.Conclusion: The TAE signature model could represent a CIT response prediction model with a prognostic value in multiple cancer types.

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Prognostic value of neutrophil‐to‐lymphocyte ratio in gastric cancer patients treated with immune checkpoint inhibitors: A meta‐analysis

Cited by 4 publications

References 41 publications

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

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

Systemic and local immunosuppression in glioblastoma and its prognostic significance

A tumor-associated endothelial signature score model in immunotherapy and prognosis across pan-cancers

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