Baseline neutrophil-to-lymphocyte ratio (NLR) and derived NLR could predict overall survival in patients with advanced melanoma treated with nivolumab
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BACKGROUND: Previous studies have suggested that elevated neutrophil-to-lymphocyte ratio (NLR) is prognostic for worse outcomes in patients with a variety of solid cancers, including those treated with immune checkpoint inhibitors. METHODS: This was a retrospective analysis of 97 consecutive patients with stage IV melanoma who were treated with nivolumab. Baseline NLR and derived (d) NLR were calculated and, along with other characteristics, correlated with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analyses. The best cutoff values for NLR and dNLR were derived using Cutoff Finder software based on an R routine which optimized the significance of the split between Kaplan-Meier survival curves. RESULTS: In univariate analysis, increasing absolute neutrophil count (ANC), NLR, dNLR and lactate dehydrogenase (LDH) (continuous variables) were all significantly associated with OS. Only NLR (hazard ratio [HR] = 2.85; 95% CI 1.60-5.08; p < 0.0001) and LDH (HR = 2.51; 95% CI 1.36-4.64; p < 0.0001) maintained a significant association with OS in multivariate analysis. Patients with baseline NLR ≥5 had significantly worse OS and PFS than patients with NLR < 5, as did patients with baseline dNLR ≥3 versus < 3. Optimal cut-off values were ≥ 4.7 for NLR and ≥ 3.8 for dNLR. Using this ≥4.7 cut-off for NLR, the values for OS and PFS were overlapping to the canonical cut-off for values, and dNLR< 3.8 was also associated with better OS and PFS. CONCLUSION: Both Neutrophil-to-lymphocyte ratio (NLR) and derived (d) NLR were associated with improved survival when baseline levels were lower than cut-off values. NLR and dNLR are simple, inexpensive and readily available biomarkers that could be used to help predict response to immunotherapy in patients with advanced melanoma.
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Melanoma patients on PD-1 therapy with high NLR had worse overall and progression-free survival than those with low NLR.
“Consistent with published studies in multiple settings21–24, PD-1-treated patients with melanoma with a high NLR had poorer survival (OS/PFS) than those with a low NLR.”
From Intestinal microbiota signatures of clinical response and immune-related adverse events in melanoma patients treated with anti-PD-1 (2022) · cites this paper as [21]
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- Authors
- Capone, M., Giannarelli, D., Mallardo, D., Madonna, G., Festino, L., Grimaldi, A. M., Vanella, V., Simeone, E., Paone, M., Palmieri, G., Cavalcanti, E., Caracò, C., & Ascierto, P. A.
- Affiliations
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT)
- Instituto Nazionale Tumori Regina Elena (IT)
- Istituto di Chimica Biomolecolare (IT)
- Corresponding author
- Ascierto, Paolo Antonio
- ORCID
- Venue
- Journal for ImmunoTherapy of Cancer
- Publisher
- BMJ
- Published
- 2018-07-16
- Volume
- 6
- Issue
- 1
- Pages
- 74-74
- ISSN
- 2051-1426 (ISSN-L)
- PMC
- PMC6048712
- OpenAlex
- W2883706035
- Cited by
- 497
- References
- 31
- Citations by year
- 2026: 31 · 2025: 70 · 2024: 84 · 2023: 74 · 2022: 81 · 2021: 65 · 2020: 61 · 2019: 24 · 2018: 5 · 2015: 1
- FWCI
- 14.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal for ImmunoTherapy of Cancer (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- UnissResearch (Università degli Studi di Sassari) (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Keywords
- neutrophil-to-lymphocyte ratio, advanced melanoma, nivolumab, immune checkpoint inhibitors, overall survival, progression-free survival, prognostic factors, lactate dehydrogenase, absolute neutrophil count, cut-off values
- MeSH terms
- Antineoplastic Agents, Immunological, Nivolumab, Adult, Aged, Aged, 80 and over, Female, Humans, Leukocyte Count, Lymphocytes, Male, Melanoma, Middle Aged, Neoplasm Metastasis, Neoplasm Staging, Neutrophils, Prognosis, Biomarkers, Treatment Outcome, Lymphocyte Count, Kaplan-Meier Estimate, Young Adult
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