State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, Guangdong 510060, People's Republic of China.
State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, Guangdong 510060, People's Republic of China.
Int Immunopharmacol. 2023 Oct;123:110703. doi: 10.1016/j.intimp.2023.110703. Epub 2023 Aug 1.
Systemic inflammation plays a role in carcinogenesis and is related to overall survival in patients with different cancer types, including those treated with immune checkpoint blockade (ICB). The neutrophil-lymphocyte ratio (NLR) is calculated by circulating neutrophil to lymphocyte counts, which represents an indicator of the balance between the deleterious roles of neutrophilia and the beneficial roles of lymphocyte-mediated immunity. We hypothesized that the NLR may predict outcomes in metastatic colorectal cancer (mCRC) patients treated with immunotherapy.
This retrospective study included 110 mCRC patients who were treated with immunotherapy at Sun Yat-sen University Cancer Center. Several inflammatory biomarkers were measured at baseline and after two cycles of treatment. The X-tile program was used to obtain the cutoff values. We examined the impact of both baseline and posttreatment inflammatory index levels on overall survival (OS).
In univariate analysis, both a low baseline NLR (P = 0.014) and a decreased NLR after 2 cycles of immunotherapy (P < 0.001) were considerably correlated with better OS. In multivariate analysis, age, liver metastasis, baseline lymphocyte-monocyte ratio (LMR), baseline NLR and early changes in NLR independently predicted OS. Patients with both a low baseline NLR and an early NLR reduction had the longest OS (median, 29.63 months). The best outcomes were remarkably observed in patients who had both an early NLR reduction and a high tumor mutational burden (TMB) (≥10 mut/Mb) (P < 0.0001).
Both a low baseline NLR and an early NLR reduction are significantly associated with a better prognosis in mCRC patients treated with immunotherapy. Further analysis indicated that the combination of NLR and TMB could obtain additional predictive power.
系统性炎症在癌症发生中起作用，并与包括接受免疫检查点阻断（ICB）治疗在内的不同癌症类型患者的总生存率相关。中性粒细胞与淋巴细胞比值（NLR）通过循环中性粒细胞与淋巴细胞计数计算得出，代表中性粒细胞增多的有害作用与淋巴细胞介导的免疫的有益作用之间的平衡指标。我们假设 NLR 可能预测接受免疫治疗的转移性结直肠癌（mCRC）患者的结局。
本回顾性研究纳入了 110 例在中山大学肿瘤防治中心接受免疫治疗的 mCRC 患者。在基线和两个周期的治疗后测量了几种炎症生物标志物。使用 X-tile 程序获得了截断值。我们研究了基线和治疗后炎症指数水平对总生存期（OS）的影响。
单因素分析中，基线 NLR 低（P=0.014）和免疫治疗 2 个周期后 NLR 降低（P<0.001）均与 OS 显著相关。多因素分析中，年龄、肝转移、基线淋巴细胞-单核细胞比值（LMR）、基线 NLR 和 NLR 的早期变化独立预测 OS。基线 NLR 低且 NLR 早期降低的患者 OS 最长（中位，29.63 个月）。在早期 NLR 降低和高肿瘤突变负担（TMB）（≥10 mut/Mb）的患者中观察到了显著的最佳结果（P<0.0001）。
基线 NLR 低和 NLR 早期降低与接受免疫治疗的 mCRC 患者的预后显著相关。进一步分析表明，NLR 和 TMB 的组合可以获得额外的预测能力。
