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Association of the neutrophil to lymphocyte ratio and clinical outcomes in patients with lung cancer receiving immunotherapy: a meta-analysis.

ABSTRACT: OBJECTIVES:To explore the relationship between the pretreatment or post-treatment neutrophil to lymphocyte ratio (NLR) and overall survival (OS)/progression-free survival (PFS) in patients with lung cancer receiving immunotherapy. DESIGN:We searched several databases to collect relevant studies conducted until July 2019. We carefully reviewed the full text of the included publications and combined the HRs and 95% CIs to assess the association between the NLR and survival time in patients with lung cancer receiving immunotherapy. DATA SOURCES:PubMed, the Cochrane Library, Embase and Web of Science ELIGIBILITY CRITERIA: Studies reporting the prognostic value of the NLR in patients with lung cancer receiving immunotherapy were enrolled. DATA EXTRACTION AND SYNTHESIS:Basic information on the articles and patients (NLR cut-off value, NLR at baseline and HRs with 95% CIs for OS and PFS) was extracted by two authors independently. The pooled HRs of OS and PFS were synthesised using the random effects or fixed effects model. RESULTS:Twenty-three studies with 2068 patients were enrolled. Among all patients, 1305 (64.0%) were men and 643 (31.4%) were diagnosed with squamous cell carcinoma (SCC). In a pooled analysis of OS and PFS from all studies, an elevated NLR predicted poor OS (HR=1.62; 95%?CI: 1.41 to 1.87; p<0.001) and PFS (HR=1.47; 95%?CI: 1.25 to 1.72; p<0.001). Subgroup analyses stratified showed that the post-treatment NLR was not significantly related to OS and that patients in Asia had significantly higher HRs than those in Europe and America. Furthermore, the proportion of SCC and baseline NLR could affect the prognostic value of the NLR. CONCLUSIONS:Our study found that an elevated NLR was associated with poor OS and PFS in patients with lung cancer receiving immunotherapy and that several clinical factors might have an impact on the predictive value of the NLR in the survival of patients with lung cancer.

SUBMITTER: Jin J

PROVIDER: S-EPMC7282333 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Association of the neutrophil to lymphocyte ratio and clinical outcomes in patients with lung cancer receiving immunotherapy: a meta-analysis.

Jin Jing J Yang Lan L Liu Dan D Li Weimin W

BMJ open 20200603 6

<h4>Objectives</h4>To explore the relationship between the pretreatment or post-treatment neutrophil to lymphocyte ratio (NLR) and overall survival (OS)/progression-free survival (PFS) in patients with lung cancer receiving immunotherapy.<h4>Design</h4>We searched several databases to collect relevant studies conducted until July 2019. We carefully reviewed the full text of the included publications and combined the HRs and 95% CIs to assess the association between the NLR and survival time in p ...[more]

PMID: 32499266

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Project description:BackgroundIt remains controversial whether the platelet to lymphocyte ratio (PLR) serves as a potential indicator for the efficacy of immunotherapy in advanced lung cancer. This meta-analysis aimed to address this concern.MethodsUp to March 2022, we searched PubMed, Embase, Web of Science and the Cochrane Library to retrieve potentially eligible articles. Combined hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to assess the relationship between PLR and progression-free survival (PFS) as well as overall survival (OS), while the combined odds ratios (ORs) and 95% CIs were estimated to evaluate the relationship between PLR and the objective response rate (ORR) as well as the disease control rate (DCR). Subgroup analyses were further performed to detect the source of heterogeneity and potential predictive value of PLR in different groups in terms of OS and PFS.ResultsA total of 21 included studies involving 2312 patients with advanced lung cancer receiving immunotherapy were included. The combined results suggested that elevated PLR was associated with poorer OS (HR=2.24; 95% CI: 1.87-2.68; I² =44%; P=0.01) and PFS (HR=1.66; 95% CI: 1.36-2.04; I² =64%; P<0.01). Furthermore, elevated PLR showed a lower ORR (OR= 0.61; 95% CI: 0.43-0.87, I²=20%; P=0.29) and DCR (OR= 0.44; 95% CI: 0.27-0.72, I²=61%; P=0.02). In subgroup analyses, pretreatment PLR was significantly associated with adverse OS and PFS. The same results were observed in different PLRs in terms of cutoff value (>200 vs. ≤200). Furthermore, high PLR was significantly associated with poor OS and PFS in advanced non-small cell lung cancer (NSCLC); however, PLR was not associated with OS and PFS in advanced small cell lung cancer (SCLC). In addition, PLR predicted poor OS irrespective of regions and types of immune checkpoint inhibitors (ICIs).ConclusionOn the whole, patients with low PLR had better OS and PFS, as well as higher ORR and DCR when receiving immunotherapy in advanced lung cancer especially for advanced NSCLC. And further investigations are warranted to confirm the prognostic value of PLR in advanced SCLC.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022315976.

Project description:ObjectivesDerived neutrophil-to-lymphocytes ratio (dNLR) has recently been reported as a novel potential biomarker associated with prognosis of non-small cell lung cancer (NSCLC). However, evidence for the prognostic utility of dNLR in patients with NSCLC treated with immune checkpoint inhibitors (ICIs) remains inconsistent. The objective of this work was to evaluate the association between pretreatment dNLR and prognosis of patients with NSCLC treated with ICIs.DesignThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesPubMed, EMBASE, Web of Science and the Cochrane Library were searched for eligible studies up to 16 October 2020. ELIGIBILITY CRITERIA: (1) Human subjects receiving ICIs therapy and who had been diagnosed with NSCLC; (2) the baseline values of dNLR were obtained; (3) the objective of the study was to investigate the relationships between dNLR and overall survival (OS) or progression-free survival (PFS) in NSCLC and (4) HR and 95% CI were displayed in the original article or could be extracted from Kaplan-Meier curves.Data extraction and synthesisTwo investigators extracted data independently. Data synthesis was performed via systematic review and meta-analysis of eligible cohort studies. Meta-analysis was performed with Cochran's Q test and I2 statistics. Publication bias of studies was assessed by Begg's test and Egger's test. We used V.12.0 of the Stata statistical software.ResultsThis analysis included eight studies (2456 cases) on the prognostic utility of dNLR in ICI therapy for NSCLC. The results indicate that higher dNLR significantly predicted poor OS (HR=1.65, 95% CI 1.46 to 1.88; p<0.001) and PFS (HR=1.38, 95% CI 1.23 to 1.55; p<0.001). Subgroup analyses of OS-related studies indicated that there were similar results in stratifications by ethnicity, sample size, type of HR and dNLR cut-off value. As for PFS-related studies, subgroup analyses showed no significant difference in Asian populations. Publication biases were not detected using Begg's test and Egger's linear regression test.ConclusionsThis meta-analysis indicated that elevated pretreatment dNLR may be a negative prognostic predictor for patients with NSCLC treated with ICIs. More large-sample and higher-quality studies are warranted to support our findings.Prospero registration numberCRD42021214034.

Dataset Information

Association of the neutrophil to lymphocyte ratio and clinical outcomes in patients with lung cancer receiving immunotherapy: a meta-analysis.

Publications

Association of the neutrophil to lymphocyte ratio and clinical outcomes in patients with lung cancer receiving immunotherapy: a meta-analysis.

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