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癌症免疫观点 ›› 2025, Vol. 1 ›› Issue (2) : 31-43.
PDF(531 KB)
PDF(531 KB)
Objective: To methodically assess the prognostic predictive value of baseline neutrophil-to-lymphocyte ratio (NLR) in cancer patients receiving immune checkpoint inhibitor (ICI) therapy.
Methods: We conducted a systematic search in PubMed, Embase, Cochrane Library, and Web of Science. The search covered studies from each database's founding to December 31, 2024. We included cohort studies or post hoc analyses from randomized controlled trials that assessed the association between baseline NLR (neutrophil-to-lymphocyte ratio) and the prognosis of ICI (immunotherapy) treatment. The Newcastle-Ottawa Scale, a tool for quality assessment of non-randomized studies, was used. Random-effect models combine effect sizes across studies. Subgroup analysis (examining results within subgroups), meta-regression (statistical exploration of heterogeneity), and sensitivity analysis (testing the robustness of the results) were performed.
Results: Sixty-eight studies, including 18,947 patients, were analyzed. Patients with high NLR (neutrophil-to-lymphocyte ratio) had significantly poorer overall survival (OS, time until death from any cause) compared to those with low NLR (combined HR=1.96, 95% CI: 1.74-2.21, P<0.001). They also had worse progression-free survival (PFS, time until disease worsens or patient dies) (combined HR=1.82, 95% CI: 1.63-2.03, P<0.001). The high NLR group showed lower objective response rate (ORR, proportion of patients with tumor shrinkage) and disease control rate (DCR, proportion of patients with tumor response or stable disease), with combined ORs of 0.42 (95% CI: 0.35-0.51) and 0.53 (95% CI: 0.44-0.64). Subgroup analysis (examining results by groups) showed consistent associations across cancer types, treatment lines, and ICI types. The NLR cutoff value (the threshold used to define high vs. low NLR) was the main source of heterogeneity (P=0.009). Sensitivity analysis (testing the effects of excluding certain studies) supported the robustness of the results.
Conclusion: Elevated baseline NLR is an independent predictor of poor prognosis in cancer patients receiving ICI therapy. As a simple, inexpensive biomarker, NLR can help screen populations that may benefit from ICI treatment.
Neutrophil-to-Lymphocyte Ratio (NLR)
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