Neutrophil to Lymphocyte ratio as a predictor for immune-related adverse events in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis
BackgroundThe use of immune checkpoint inhibitors (ICIs) in cancer treatment has led to an increase in immune-related adverse events (irAEs), which can cause treatment discontinuation and even fatal reactions. The purpose of this study was to evaluate the usefulness of the peripheral biomarker neutr...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-08-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1234142/full |
| _version_ | 1797749018989690880 |
|---|---|
| author | Wei Zhang Yifei Tan Yuquan Li Jiang Liu |
| author_facet | Wei Zhang Yifei Tan Yuquan Li Jiang Liu |
| author_sort | Wei Zhang |
| collection | DOAJ |
| description | BackgroundThe use of immune checkpoint inhibitors (ICIs) in cancer treatment has led to an increase in immune-related adverse events (irAEs), which can cause treatment discontinuation and even fatal reactions. The purpose of this study was to evaluate the usefulness of the peripheral biomarker neutrophil to lymphocyte ratio (NLR) in predicting irAEs.MethodsA systematic search of databases was conducted to identify studies on the predictive value of NLR for irAEs. The standardized mean difference (SMD) was used to compare continuous NLR, while crude odds ratios (ORs) were calculated for categorized NLR if adjusted ORs and 95% confidence intervals (CIs) were not provided in the original study.ResultsThe meta-analysis included 47 studies with a total of 11,491 cancer patients treated with ICIs. The baseline continuous NLR was significantly lower in patients with irAEs compared to those without (SMD=-1.55, 95%CI=-2.64 to -0.46, P=0.006). Similarly, categorized NLR showed that lower baseline NLR was associated with increased irAEs (OR=0.55, 95%CI=0.41-0.73, P<0.001). Subgroup analysis revealed that the OR for predicting irAEs with NLR cut-off values of 3 and 5 was 0.4 and 0.59, respectively. Interestingly, increased baseline NLR was associated with a higher incidence of immune-related liver injury (OR=2.44, 95%CI=1.23-4.84, I2 = 0%, P=0.010).ConclusionOur study suggests that lower baseline NLR is associated with a higher risk of overall irAEs. However, further studies are needed to determine the best cut-off value and explore the efficacy of NLR in predicting specific types of irAEs. |
| first_indexed | 2024-03-12T16:13:11Z |
| format | Article |
| id | doaj.art-24cd9f98abd847a69cc1aaee602627c5 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-12T16:13:11Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-24cd9f98abd847a69cc1aaee602627c52023-08-09T09:17:56ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-08-011410.3389/fimmu.2023.12341421234142Neutrophil to Lymphocyte ratio as a predictor for immune-related adverse events in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysisWei Zhang0Yifei Tan1Yuquan Li2Jiang Liu3Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, ChinaDepartment of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, ChinaBreast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, ChinaBackgroundThe use of immune checkpoint inhibitors (ICIs) in cancer treatment has led to an increase in immune-related adverse events (irAEs), which can cause treatment discontinuation and even fatal reactions. The purpose of this study was to evaluate the usefulness of the peripheral biomarker neutrophil to lymphocyte ratio (NLR) in predicting irAEs.MethodsA systematic search of databases was conducted to identify studies on the predictive value of NLR for irAEs. The standardized mean difference (SMD) was used to compare continuous NLR, while crude odds ratios (ORs) were calculated for categorized NLR if adjusted ORs and 95% confidence intervals (CIs) were not provided in the original study.ResultsThe meta-analysis included 47 studies with a total of 11,491 cancer patients treated with ICIs. The baseline continuous NLR was significantly lower in patients with irAEs compared to those without (SMD=-1.55, 95%CI=-2.64 to -0.46, P=0.006). Similarly, categorized NLR showed that lower baseline NLR was associated with increased irAEs (OR=0.55, 95%CI=0.41-0.73, P<0.001). Subgroup analysis revealed that the OR for predicting irAEs with NLR cut-off values of 3 and 5 was 0.4 and 0.59, respectively. Interestingly, increased baseline NLR was associated with a higher incidence of immune-related liver injury (OR=2.44, 95%CI=1.23-4.84, I2 = 0%, P=0.010).ConclusionOur study suggests that lower baseline NLR is associated with a higher risk of overall irAEs. However, further studies are needed to determine the best cut-off value and explore the efficacy of NLR in predicting specific types of irAEs.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1234142/fullimmune checkpoint inhibitorsimmune-related adverse eventsneutrophil to lymphocyte ratiobiomarkercancer treatment |
| spellingShingle | Wei Zhang Yifei Tan Yuquan Li Jiang Liu Neutrophil to Lymphocyte ratio as a predictor for immune-related adverse events in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis Frontiers in Immunology immune checkpoint inhibitors immune-related adverse events neutrophil to lymphocyte ratio biomarker cancer treatment |
| title | Neutrophil to Lymphocyte ratio as a predictor for immune-related adverse events in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis |
| title_full | Neutrophil to Lymphocyte ratio as a predictor for immune-related adverse events in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis |
| title_fullStr | Neutrophil to Lymphocyte ratio as a predictor for immune-related adverse events in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis |
| title_full_unstemmed | Neutrophil to Lymphocyte ratio as a predictor for immune-related adverse events in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis |
| title_short | Neutrophil to Lymphocyte ratio as a predictor for immune-related adverse events in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis |
| title_sort | neutrophil to lymphocyte ratio as a predictor for immune related adverse events in cancer patients treated with immune checkpoint inhibitors a systematic review and meta analysis |
| topic | immune checkpoint inhibitors immune-related adverse events neutrophil to lymphocyte ratio biomarker cancer treatment |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1234142/full |
| work_keys_str_mv | AT weizhang neutrophiltolymphocyteratioasapredictorforimmunerelatedadverseeventsincancerpatientstreatedwithimmunecheckpointinhibitorsasystematicreviewandmetaanalysis AT yifeitan neutrophiltolymphocyteratioasapredictorforimmunerelatedadverseeventsincancerpatientstreatedwithimmunecheckpointinhibitorsasystematicreviewandmetaanalysis AT yuquanli neutrophiltolymphocyteratioasapredictorforimmunerelatedadverseeventsincancerpatientstreatedwithimmunecheckpointinhibitorsasystematicreviewandmetaanalysis AT jiangliu neutrophiltolymphocyteratioasapredictorforimmunerelatedadverseeventsincancerpatientstreatedwithimmunecheckpointinhibitorsasystematicreviewandmetaanalysis |