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Published online: 2024-05-16

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Unlocking the potential: the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) as biomarkers informing immunotherapy outcomes in lung cancer patients — single oncology center experience and literature review

Tomasz Jankowski1, Natalia Krzyżanowska1, Kamila Wojas-Krawczyk1, Aleksandra Grzywna1, Paweł Krawczyk1, Izabela Chmielewska1, Michał Szczyrek1, Janusz Milanowski1


Introduction. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), two promising biomarkers of effectiveness of cancer immunotherapy, have obtained great attention in recent years. The NLR and PLR are both simple and readily available markers derived from routine blood tests. It is postulated that integrating these biomarkers into clinical practice could facilitate monitoring immunotherapy effects. In this study, we retrospectively examined NLR and PLR values in non-small cell lung cancer patients (NSCLC) receiving second-line immunotherapy. 

Material and methods. The study group included 73 NSCLC patients: 38 men and 35 women. Twenty-three patients were diagnosed with squamous cell carcinoma (SqCC), and 50 patients with non-squamous cell carcinoma (non-SqCC). We assessed NLR and PLR values at immunotherapy initiation (NLR1, PLR1) and after 3 months of the follow-up (NLR2 and PLR2). These parameters were correlated with the clinical characteristics of patients, response to treatment, progression-free survival (PFS), and overall survival (OS). 

Results. The values of PLR1 and delta PLR were significantly higher in non-SqCC patients compared to SqCC patients. Other clinical and demographic factors did not influence the values of NLR1, NLR2, PLR2, or delta NLR. Medians of NLR1 and NLR2 were significantly lower in patients with controlled disease than in patients with disease progression. Patients with PFS longer than 12 months had a significantly lower median NLR2 than patients with PFS shorter than 1 year. A factor that significantly increased the risk of progression and death was a high NLR2 value. 

Conclusions. NLR and PLR represent promising biomarkers for monitoring immunotherapy effectiveness in cancer patients, which offer insights into the dynamic interplay between the host immune system and tumor biology. Further research is warranted to validate their utility in larger patient cohorts and standardize their incorporation into clinical practice.

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