Prognostic value of inflammatory markers NLR, PLR, and LMR in gastric cancer patients treated with immune checkpoint inhibitors: a meta-analysis and systematic review.
Immune checkpoint inhibitors (ICIs) represent a groundbreaking approach to cancer therapy. Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) have emerged as potential indicators strongly associated with tumor prognosis, albeit their prognostic significance remains contentious. The predictive value of NLR, PLR, LMR in patients with gastric cancer (GC) treated with ICIs has not been fully explored; therefore, we conducted a meta-analysis to examine the potential of inflammatory markers NLR, PLR, and LMR as survival predictors in this population.
A comprehensive search was conducted across PubMed, Embase, Web of Science, and Cochrane databases, with the search cut-off date set as March 2024. Hazard ratios (HR) and their corresponding 95% confidence intervals (CI) were calculated to assess the prognostic significance of NLR, PLR, and LMR for both progression-free survival (PFS) and overall survival (OS).
Fifteen cohort studies involving 1336 gastric cancer patients were finally included in this meta-analysis. The results of the meta-analysis showed that high levels of NLR were associated with poorer OS and PFS in GC patients receiving ICIs, with combined HRs of OS [HR=2.01, 95%CI (1.72,2.34), P<0.01], and PFS PFS[HR=1.59, 95%CI (1.37,1.86), P<0.01], respectively; high levels of PLR were associated with poorer OS and PFS, and the combined HR was OS [HR=1.57, 95%CI (1.25,1.96), P<0.01], PFS [HR=1.52,95%CI (1.20, 1.94), P<0.01], respectively; and there was an association between elevated LMR and prolonged OS and PFS, and the combined HR was OS [HR=0.62, 95%CI (0.47,0.81), P<0.01], and PFS [HR=0.69, 95%CI (0.50,0.95), P<0.01].
In gastric cancer (GC) patients treated with immune checkpoint inhibitors (ICIs), elevated neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with poorer overall survival (OS) and progression-free survival (PFS), while high lymphocyte-to-monocyte ratio (LMR) was linked to improved OS and PFS. Subgroup analyses suggested that NLR might be particularly pertinent to the prognosis of GC patients. In conclusion, the inflammatory markers NLR, PLR, and LMR serve as effective biomarkers for prognostic assessment in GC patients, offering valuable insights for therapeutic decision-making in the realm of GC immunotherapy. Prospective studies of high quality are eagerly awaited to validate these findings in the future.
https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier CRD42024524321.
Tan S
，Zheng Q
，Zhang W
，Zhou M
，Xia C
，Feng W
... -
《Frontiers in Immunology》
Diagnostic and Prognostic Role of Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio and Lymphocyte/Monocyte Ratio in Pediatric Sarcomas.
The correlation between the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) with prognosis has been observed in different types of adult sarcomas. However, there is insufficient evidence in pediatric tumors. Our study aimed to examine if alterations in these characteristics serve as prognostic indicators in juvenile sarcomas.
A cohort group of 138 patients including Ewing sarcoma (n = 62), osteosarcoma (n = 52), and rhabdomyosarcoma (n = 24), the most common pediatric sarcomas diagnosed and treated in our institute between January 2006 and December 2022, were retrospectively evaluated. Pre-treatment values of NLR, PLR, and LMR were calculated for all patients. These values were then evaluated about overall survival (OS) and disease-free survival (DFS), along with other established prognostic variables.
In terms of area under the ROC curve (AUC) values, NLR and LMR in osteosarcoma, NLR and PLR in Ewing sarcoma, and NLR in rhabdomyosarcoma were statistically significant. In patients with osteosarcoma (OS), NLR ≥ 3 and LMR < 5.3 were found to be an independent prognostic factor for overall survival in multivariate analysis (HR, 2, 95% [CI], 1.1-8; P = 0.049 and HR, 2.1, 95% [CI], 1.3-8.3; P = 0.046, respectively). Furthermore, positive surgical margins were found to be an independent prognostic factor in OS patients (HR, 2.7, 95% CI, 1-9.2; P = 0.045). In multivariate analysis, cut-off values of NLR ≥ 2.1 and PLR ≥ 194 were determined as prognostic factors for overall survival in patients with Ewing sarcoma (ES) (HR, 2.2, 95% [CI], 1-6.8; P = 0.048, HR, 3.2, 95% [CI], 1.1-9; P = 0.035, respectively). Metastatic disease was found to be correlated with poorer overall and disease-free survival rates in patients with ES. The hazard ratio for overall survival was 4 (95% confidence interval: 2.1-17.4; P = 0.03), while the hazard ratio for disease-free survival was 2.3 (95% confidence interval: 2-4.9; P = 0.024). In the rhabdomyosarcoma (RMS) group, surgical margin positivity and NLR ≥ 4.6 were associated with worse overall survival rates in univariate analysis (HR, 4, 95% CI, 1.6-27.2; P = 0.029 and HR, 2.2, 95% CI, 1.05-6.9; P = 0.046, respectively).
Our study revealed that elevated NLR hurt OS and DFS in patients with osteosarcoma and Ewing sarcoma. Low LMR and high PLR were also associated with poor prognosis in these diseases, even in the presence of heterogeneity. In the rhabdomyosarcoma group, however, none of the markers provided a significant prognostic contribution.
Erdogan F
，Çinka H
，Yurtbay A
，Sezgin H
，Coskun HS
，Dabak N
... -
《Nigerian Journal of Clinical Practice》
The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients: a retrospective study.
The purpose of this study was to investigate the influence and predictive value of preoperative peripheral blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) index on the prognosis of colorectal anastomotic leakage (CAL) patients.
This study retrospectively analyzed the clinical data of 1016 patients who underwent radical resection for colorectal cancer at a single center between January 1, 2007 and December 31, 2023. In this study, NLR and PLR were analyzed before surgery. Kaplan-Meier survival analysis was performed according to the postoperative survival status of the patients. Nomogram and calibration curve were established by proportional hazards model (COX) to verify its predictive value.
A total of 890 patients with colorectal cancer, 102 patients with CAL, and 788 patients with non- anastomotic leakage (AL) colorectal cancer were enrolled for a median follow-up of 96 months (quartile range 33-133). In this study, COX regression analysis showed that preoperative NLR and PLR could predict the prognosis of CAL patients, and the optimal cut-off points of NLR and PLR were 2.89 and 157.62, respectively. Kaplan-Meier survival curve results showed that 5-year overall survival (OS) and disease-free survival (DFS) in the low NLR and PLR group were significantly higher than those in the high NLR and PLR group. OS and DFS were divided into high, low NLR and PLR groups. Finally, based on COX model, a nomogram analysis was conducted to analyze the risk factors affecting OS and DFS, and the accuracy and practicality of the model were verified by calibration curve and decision curve.
Preoperative NLR and PLR can predict the long-term prognosis of colorectal cancer (CRC) and CAL patients, and patients with NLR ≥ 2.89 and PLR ≥ 157.62 have poor survival prognosis. Nomogram and calibration curve analysis will further improve the accuracy of OS and DFS prediction.
Xu N
，Zhang JX
，Zhang JJ
，Huang Z
，Mao LC
，Zhang ZY
，Jin WD
... -
《BMC Surgery》
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