Neutrophil-to-Lymphocyte Ratio Predicts Development of Immune-Related Adverse Events and Outcomes from Immune Checkpoint Blockade: A Case-Control Study

• Published in: Cancers Vol. 13; no. 6; p. 1308
• Main Authors: Lee, Pei Yi, Oen, Kellynn Qi Xuan, Lim, Grace Rui Si, Hartono, Juanda Leo, Muthiah, Mark, Huang, Daniel Q, Teo, Felicia Su Wei, Li, Andrew Yunkai, Mak, Anselm, Chandran, Nisha Suyien, Tan, Chris Lixian, Yang, Peiling, Tai, E Shyong, Ng, Kay Wei Ping, Vijayan, Joy, Chan, Yee Cheun, Tan, Li Ling, Lee, Martin Beng-Huat, Chua, Horng Ruey, Hong, Wei Zhen, Yap, Eng Soo, Lim, Dawn K, Yuen, Yew Sen, Chan, Yiong Huak, Aminkeng, Folefac, Wong, Alvin Seng Cheong, Huang, Yiqing, Tay, Sen Hee
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 15.03.2021; MDPI
• Subjects: Adverse events; Blood platelets; Cancer therapies; Chemotherapy; Clinical outcomes; Immune checkpoint inhibitors; Leukocytes (neutrophilic); Lung cancer; Lymphocytes; Medical prognosis; Multivariate analysis; Neutrophils; Patients; Regression analysis; Risk factors; neutrophil-to-lymphocyte ratio; immune-related adverse events; immunotherapy; survival
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers13061308

The utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) utility in predicting immune-related adverse events (irAEs) and survival have not been well studied in the context of treatment with immune checkpoint inhibitors (ICIs). We performed a case-control study of cancer patients who received at least one dose of ICI in a tertiary hospital. We examined NLR and PLR in irAE cases and controls. Logistic and Cox regression models were used to identify independent risk factors for irAEs, progression-free survival (PFS), and overall survival (OS). The study included 91 patients with irAEs and 56 controls. Multiple logistic regression showed that NLR < 3 at baseline was associated with higher occurrence of irAEs. Multivariate Cox regression showed that development of irAEs and reduction in NLR from baseline to week 6 were associated with longer PFS. Higher NLR values at baseline and/or week 6 were independently associated with shorter OS. A reduction in NLR from baseline to week 6 was associated with longer OS. In this study of cancer patients treated with ICIs, NLR has a bidirectional relationship with adverse outcomes. Lower NLR was associated with increased occurrence of irAEs while higher NLR values were associated with worse clinical outcomes.