Han Lu, Huang Beibei, Li Linlin, Xu Benling, Yang Yonghao, Zhao Lingdi, Wang Zibing, Zhang Chaoji, Gao Quanli
Department of Immunology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China.
Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
J Leukoc Biol. 2025 May 7;117(5). doi: 10.1093/jleuko/qiaf029.
Differential diagnosis of immune-related adverse events (irAEs) or bacterial infections is sometimes very difficult in cancer patients undergoing treatment with PD-(L)1 inhibitors. This study aimed to assess the effectiveness of the neutrophil-to-lymphocyte ratio (NLR) in distinguishing between irAEs and bacterial infections in cancer patients receiving PD-(L)1 inhibitors. We conducted a retrospective analysis of cancer patients who received at least 1 dose of PD-(L)1 inhibitors at Affiliated Cancer Hospital of Zhengzhou University from 2018 to 2023. We compared the changes in peripheral blood cell counts before and after the occurrence of adverse events, as well as the ratios of the NLR that were closest after the occurrence of adverse events (post-NLR) to the NLR that were closest before the occurrence of adverse events (pre-NLR). Among the 4173 patients who were administered PD-(L)1 inhibitors, 217 individuals experienced a total of 249 irAEs, while 256 patients were diagnosed with 257 bacterial infections. The post-NLR increased significantly compared with pre-NLR in patients with bacterial infection (P < 0.001), while the post-NLR had smaller increase compared with pre-NLR in patients sufffering irAEs (P < 0.001). Notably, the NLR was significantly higher in patients with bacterial infection compared with those with irAEs (P < 0.001). Furthermore, the post-NLR/pre-NLR ratio was higher in the bacterial infection group than in the irAEs group (P < 0.001). The NLR along with the post-NLR/pre-NLR ratio could serve as valuable diagnostic indicators for irAEs and bacterial infections in cancer patients undergoing treatment with PD-(L)1 inhibitors.
对于正在接受PD-(L)1抑制剂治疗的癌症患者而言，免疫相关不良事件（irAEs）与细菌感染的鉴别诊断有时非常困难。本研究旨在评估中性粒细胞与淋巴细胞比值（NLR）在接受PD-(L)1抑制剂治疗的癌症患者中区分irAEs和细菌感染的有效性。我们对2018年至2023年在郑州大学附属肿瘤医院接受至少1剂PD-(L)1抑制剂治疗的癌症患者进行了回顾性分析。我们比较了不良事件发生前后外周血细胞计数的变化，以及不良事件发生后最接近的NLR（NLR-post）与不良事件发生前最接近的NLR（NLR-pre）的比值。在接受PD-(L)1抑制剂治疗的4173例患者中，217例患者共发生249次irAEs，而256例患者被诊断为257次细菌感染。细菌感染患者的NLR-post较NLR-pre显著升高（P<0.001），而发生irAEs的患者NLR-post较NLR-pre升高幅度较小（P<0.001）。值得注意的是，细菌感染患者的NLR显著高于irAEs患者（P<0.001）。此外，细菌感染组的NLR-post/NLR-pre比值高于irAEs组（P<0.001）。NLR以及NLR-post/NLR-pre比值可作为接受PD-(L)1抑制剂治疗的癌症患者irAEs和细菌感染的有价值诊断指标。
