Predictive value of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in non-small cell lung cancer patients treated with immune checkpoint inhibitors: A meta-analysis

Abstract

BackgroundHigh neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are associated with poor prognosis in cancer patients treated with Immune checkpoint inhibitors (ICIs). However, whether this relationship exists in non-small cell lung cancer (NSCLC) patients remains unclear. Thus, this meta-analysis was conducted to investigate the prognostic role of NLR and PLR in NSCLC treated with ICIs. MethodsEligible studies that evaluated the value of pre-treatment or post-treatment NLR/PLR in NSCLC patients received ICIs were obtained by searching PubMed, Web of Science, Cochrane Library, and EMBASE. The pooled hazard ratio (HR) and 95% confidence interval (CI) were used to assess the relationship between NLR/PLR and overall survival (OS) and progression-free survival (PFS). Subgroup analysis and publication bias were conducted to investigate heterogeneity. Results1845 NSCLC patients from 21 studies were included and three ICIs(nivolumab, pembrolizumab, and atezolizumab) were used. Overall, high NLR was associated with poor OS (HR: 2.50, 95% CI:1.79–3.51, P < 0.001) and PFS (HR: 1.77, 95% CI:1.51–2.01, P < 0.001). Subgroup analyses were consistent with the pooled results. Similarly, the pooled results for PLR showed that elevated PLR was related to inferior OS (HR: 1.93, 95% CI: 1.51–2.01, P < 0.001) and PFS (HR: 1.57, 95%CI: 1.30–1.90, P < 0.001). However, the subgroup analysis based on test time indicated that there was no significant correlation between post-treatment PLR and survival outcomes. ConclusionNLR and pre-treatment PLR could serve as prognostic biomarkers in NSCLC patients treated with ICIs. However, the value of post-treatment PLR needs further to be evaluated.