217P - Neutrophil-to-lymphocyte ratio is a useful biomarker for predicting worse clinical outcome in chemo-resistant urothelial carcinoma patients treated with pembrolizumab

Background

No reliable biomarker is available for predicting worse clinical outcome in chemo-resistant urothelial carcinoma (UC) patients treated with pembrolizumab. We focused on the neutrophil-lymphocyte ratio (NLR), which is reported to be a simple index of systemic inflammation and a possible biomarker for predicting prognosis in various malignancies, including UC. Our aim was to evaluate whether a high NLR level could predict subsequent clinical outcomes in chemo-resistant UC patients treated with pembrolizumab.

Methods

We identified 74 cases treated with pembrolizumab for chemo-resistant UC between December 2017 and April 2019 at our 5 institutions. We investigated the association between NLR levels and their prognosis. We defined patients with NLR of > 3.37 as the high NLR group according to a calculation by receiver-operating curve analysis.

Results

The high NLR group consisted of 30 cases (40.5%). The 6-month progression-free survival (PFS) rate for the high NLR group was 10.0±5.5%, which was significantly lower than that for their counterpart (44.8±7.8%, p < 0.001). Multivariate Cox regression analysis revealed that elevated NLR (p < 0.001) and liver metastases (p = 0.003) were independent indicators for disease progression. Furthermore, the 6-month cancer-specific survival (CSS) rate for the high NLR group (64.5±9.1%) was significantly lower than that for their counterpart (88.8±5.3%, p = 0.004). Multivariate analysis revealed that an elevated NLR was the only independent indicator for cancer-specific death (p = 0.008). The change of NLR level before and after pembrolizumab was elevated in 46 cases. The 6-month PFS and CSS rate for the increased NLR group (17.8±6.0% and 71.9±7.3%) was significantly lower than that for their counterpart (47.0±10.6% and 90.9±6.1%, p = 0.012 and p = 0.009).

Conclusions

Elevated NLR could identify a population with a poor response to pembrolizumab treatment among chemo-resistant UC patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Koichiro Ogihara.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.