Abstract
Background and Aims Biomarkers for systemic inflammation have been introduced into clinical practice for risk-rating in cancer patients' treatment. This study is aimed at confirming the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) as an effective biomarker for patients with metastatic gastric cancer (MGC) receiving anti-PD-1 agents. Method Patients with MGC who received anti-PD-1 treatment at the Chinese PLA General Hospital between January 2016 and November 2020 were reviewed. The study analyzed the association of NLR and overall survival (OS) or progression-free survival (PFS) and antitumor response rate with PD-1 inhibitors. Results 137 patients were included in the final analysis. The area under the curve value of NLR for 6-month OS was 0.71. The best cut-off value for NLR was 3.23. NLR < 3.23 was associated with longer OS (HR = 0.38, 95% CI, 0.26-0.57, p < 0.001) and PFS (HR = 0.42, 95% CI, 0.29-0.62, p < 0.001) in patients with MGC. No significant difference was observed in the objective response rate (ORR) (35.8% vs. 28.6%, p = 0.377) and disease control rate (DCR) (86.4% vs. 78.6%, p = 0.229) in the NLR < 3.23 group and in the NLR ≥ 3.23 group, respectively. Univariate analysis and multivariate analysis found that NLR was an independent prognosis biomarker for PFS and OS. Conclusions Pretreatment elevated NLR was significantly associated with inferior PFS and OS in patients with MGC who received anti-PD-1 inhibitors. Clinicians need to consider patients with elevated NLR for decisions on immunotherapy strategy.
Highlights
Gastric cancer (GC) is the second most common cause of death amongst cancers, according to the statistics of 2015 in China [1]
IgG4 monoclonal antibodies blocking the programmed death-1 (PD-1) receptor) are considered the mainstay treatment for patients with metastatic gastric cancer (MGC) who failed to respond to chemotherapy [10, 11]
neutrophil-to-lymphocyte ratio (NLR) has been recognized as a prognostic predictor of survival in patients undergoing surgery with gastric cancer at the early stage [24] or patients with late stage treated with chemotherapy or Nivolumab monotherapy [21, 25,26,27,28,29,30,31]
Summary
Gastric cancer (GC) is the second most common cause of death amongst cancers, according to the statistics of 2015 in China [1]. Pembrolizumab was shown to be nonsuperior to chemotherapy in the first- and second-line treatments in the clinical trials [12, 13] Another anti-PD-1 agent called Nivolumab, when combined with chemotherapy as first line, was more effective than the standard treatment in AGC and MGC, irrespective of tumor programmed death ligand-1 (PD-L1) expression [14]. In most cases, assessing these potential biomarkers is expensive, time-consuming, or not routinely feasible during therapy They cannot be applied for an upfront selection of patients. NLR has been recognized as a prognostic predictor of survival in patients undergoing surgery with gastric cancer at the early stage [24] or patients with late stage treated with chemotherapy or Nivolumab monotherapy [21, 25,26,27,28,29,30,31]. ECOG PS: Eastern Cooperative Oncology Group Performance Status; PD-L1: programmed death ligand-1
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