Systemic immune‐inflammation index, neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio can predict clinical outcomes in patients with metastatic non‐small‐cell lung cancer treated with nivolumab

Abstract

Background Explore markers to predict the clinical outcomes of checkpoint inhibitors have high unmet needs. The following study investigates whether hematologic parameter such as systemic immune‐inflammation index (SII), neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR) is associated with nivolumab efficacy in advanced non‐small‐cell lung cancer (NSCLC). Methods Advanced/metastatic NSCLC patients treated with nivolumab monotherapy for second‐line or further‐line treatment at Jilin Cancer Hospital between March 2016 and July 2018 were enrolled in this retrospective study. The optimal cutoff values of SII, NLR, and PLR for predicting efficacy and prognosis were determined according to receiver operating characteristic (ROC) curve and the areas under the ROC curve. Progression‐free survival (PFS) and overall survival (OS) were calculated and compared using Kaplan‐Meier method and log‐rank test. Prognostic values of each variable were evaluated with univariate and multivariate Cox proportional hazard regression (PHR) analyses. Results A total of 44 patients with advanced NSCLC were included; the median age was 60 (range: 43‐74). The optimal cutoff value of SII/NLR/PLR predicted PFS and OS was 603.5, 3.07, and 144. Low SII, NLR, and PLR were associated with longer PFS (HR for SII = 0.34, 95%CI 0.15‐0.76, P = 0.006; HR for NLR = 0.46, 95%CI 0.22‐0.99, P = 0.048; HR for PLR = 0.39, 95%CI 0.17‐0.94, P = 0.025) and OS (HR for SII = 0.16, 95%CI 0.05‐0.51, P = 0.005; HR for NLR = 0.20, 95%CI 0.06‐0.62, P = 0.002; HR for PLR = 0.20, 95%CI 0.06‐0.73, P = 0.008). NLR ≤ 3.07, PLR ≤ 144, SII ≤ 603.5 were independently associated with longer PFS and OS. Conclusion The SII, NLR, and PLR are promising prognostic predictor for patients with metastatic NSCLC patients.

Role of hematological parameters in the diagnosis of influenza virus infection in patients with respiratory tract infection symptoms

“…Influenza virus infection induced a relatively increased N count and a relatively decreased L count, which was different from the changes caused by other common viruses such as adenovirus, respiratory syncytial virus, EB virus, human herpes virus type 6, and enterovirus . In addition, NLR was as a more sensitive parameter for influenza virus infection than the other cell count parameters in our study, which was consistent with reports on many other diseases, such as lung cancer and swine flu . A hemogram is a basic investigation performed in all admitted patients (including patients with respiratory tract infection), and NLR can be easily calculated from the results.…”

“…Furthermore, antigen tests have poor sensitivity to some influenza viruses . Recently, it was reported that hematological inflammatory indexes based on blood cell analysis had an important predictive value for the prognosis of infections, cancers, and many other diseases . This study aimed to conduct a retrospective analysis of hematological inflammatory parameters (eg, neutrophils, lymphocytes, platelets) and blood cell count indexes, particularly the NLR, in hospitalized patients with suspected influenza.…”

EPSILoN: A Prognostic Score for Immunotherapy in Advanced Non-Small-Cell Lung Cancer: A Validation Cohort

“…The evaluation of different biomarkers in a single prognostic score rather than focusing on a single biomarker permits to better identify patients who most likely will (or will not) benefit from ICIs [13]. Many immune-based prognostic scores were studied using clinical features and blood biomarkers such as lung immune prognostic index (LIPI) [50], advanced lung cancer inflammation index (ALI) [59], immunotherapy sex-ECOG-NLR-delta NLR (iSEND) [60], systemic inflammation index (SII) [18,61] and aggregate index of systemic inflammation (AISI) [61]. All these scores incorporated NLR and most of them included ECOG PS and LDH.…”

“…The LIPI score from Mezquita et al was the only one with a validation set of patients treated with ICIs and a control cohort of patients treated with chemotherapy alone in the same setting [50]. Moreover, some of the reported scores were not associated with survival at baseline [50,59,61] but only at time-series analysis (i.e., at 6 weeks of treatment) [18].…”

Retrospective Efficacy Analysis of Immune Checkpoint Inhibitor Rechallenge in Patients with Non-Small Cell Lung Cancer

“…All statistical tests were two-sided, and p-values < 0.05 were regarded as statistically significant. The cutoff values for body mass index (BMI), albumin, lactate dehydrogenase (LDH), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), and C-reactive protein (CRP) following prior therapy were determined according to previous reports [10][11][12][13][14][15]. The PFS and OS were calculated using the Kaplan-Meier method, and differences were compared using the log-rank test.…”