421P - The association between early changes in neutrophil-lymphocyte ratio and survival in patients treated with immunotherapy

Background

Dynamic changes in the blood-based biomarkers could be used as a prognostic biomarker in patients treated with immune checkpoint inhibitors (ICIs), although the data is limited. We evaluated the association between neutrophil-lymphocyte ratio (NLR) and early NLR changes with survival in ICI-treated patients. Additionally, we created an NLR-based compound prognostic score.

Methods

We retrospectively evaluated the data of 231 patients with advanced-stage cancer. We recorded baseline clinical characteristics, baseline NLR and fourth-week NLR changes, and survival data. Survival analyses were conducted with Kaplan-Meier and Cox regression analyses. A compound model was developed with the following parameters: Baseline NLR (<5 vs. ≥5), ECOG status (0 vs. ≥1), Charlson Comorbidity Index (CCI, <9 vs. ≥9), and fourth-week NLR change (10% or over NLR increase).

Results

In multivariable analyses, higher NLR (HR: 1.743, p=0.002), 10% or over NLR increase in the fourth week of treatment (HR: 1.807, p=0.001), higher ECOG performance score (HR: 1.552, p=0.006), higher LDH levels (HR: 1.454, p=0.017) and higher CCI (HR: 1.400, p=0.041) was associated with decreased OS. Compared to patients with the lowest scores, patients in the highest score group had significantly lower OS (HR: 7.967, 95% CI: 3.531-17.979, p<0.001) and PFS. The composite score had moderate success for survival prediction with an AUC of 0.702 (95% CI: 0.626-0.779, p<0.001).

Conclusions

We observed significantly lower survival in patients with higher baseline NLR values and increased NLR values under treatment. Additionally, our proposed model, including these parameters, had a moderate predictive power for OS.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.