Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, China.
Front Immunol. 2023 Aug 9;14:1234142. doi: 10.3389/fimmu.2023.1234142. eCollection 2023.
The use of immune checkpoint inhibitors (ICIs) in cancer treatment has led to an increase in immune-related adverse events (irAEs), which can cause treatment discontinuation and even fatal reactions. The purpose of this study was to evaluate the usefulness of the peripheral biomarker neutrophil to lymphocyte ratio (NLR) in predicting irAEs.
A systematic search of databases was conducted to identify studies on the predictive value of NLR for irAEs. The standardized mean difference (SMD) was used to compare continuous NLR, while crude odds ratios (ORs) were calculated for categorized NLR if adjusted ORs and 95% confidence intervals (CIs) were not provided in the original study.
The meta-analysis included 47 studies with a total of 11,491 cancer patients treated with ICIs. The baseline continuous NLR was significantly lower in patients with irAEs compared to those without (SMD=-1.55, 95%CI=-2.64 to -0.46, P=0.006). Similarly, categorized NLR showed that lower baseline NLR was associated with increased irAEs (OR=0.55, 95%CI=0.41-0.73, P<0.001). Subgroup analysis revealed that the OR for predicting irAEs with NLR cut-off values of 3 and 5 was 0.4 and 0.59, respectively. Interestingly, increased baseline NLR was associated with a higher incidence of immune-related liver injury (OR=2.44, 95%CI=1.23-4.84, I2 = 0%, P=0.010).
Our study suggests that lower baseline NLR is associated with a higher risk of overall irAEs. However, further studies are needed to determine the best cut-off value and explore the efficacy of NLR in predicting specific types of irAEs.
免疫检查点抑制剂（ICIs）在癌症治疗中的应用导致免疫相关不良事件（irAEs）的增加，这可能导致治疗中断甚至致命反应。本研究旨在评估外周生物标志物中性粒细胞与淋巴细胞比值（NLR）在预测 irAEs 中的有用性。
系统检索数据库，以确定 NLR 预测 irAEs 的价值的研究。如果原始研究未提供调整后的比值比（OR）和 95%置信区间（CI），则使用标准化均数差（SMD）比较连续 NLR，而对于分类 NLR，则计算未调整的 OR。
荟萃分析纳入了 47 项研究，共纳入了 11491 例接受 ICI 治疗的癌症患者。与无 irAEs 的患者相比，irAEs 患者的基线连续 NLR 显著降低（SMD=-1.55，95%CI=-2.64 至-0.46，P=0.006）。同样，分类 NLR 表明，较低的基线 NLR 与增加的 irAEs 相关（OR=0.55，95%CI=0.41-0.73，P<0.001）。亚组分析表明，NLR 截断值为 3 和 5 预测 irAEs 的 OR 分别为 0.4 和 0.59。有趣的是，基线 NLR 升高与免疫相关肝损伤的发生率较高相关（OR=2.44，95%CI=1.23-4.84，I2=0%，P=0.010）。
我们的研究表明，较低的基线 NLR 与较高的总体 irAEs 风险相关。然而，需要进一步的研究来确定最佳截断值，并探讨 NLR 预测特定类型 irAEs 的疗效。
