Prognostic Role of Early Dynamic Changes in Neutrophil-to-Lymphocyte Ratio of Nonsmall Cell Lung Cancer Patients

To explore the relationship between early dynamic changes in neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) and treatment outcomes of patients with advanced nonsmall cell lung cancer (NSCLC) undergoing immunotherapy, we retrospectively analyzed 217 advanced NSCLC patients who received immunotherapy. NLR and LMR at baseline and 3 weeks after initiation of treatment and changes of NLR and LMR were calculated. Univariate and multivariable COX regression analysis was applied to explore the predictors of overall survival (OS). One hundred six (48.8%) demonstrated an increase in NLR after 3 weeks of initiating treatment, while 111 (51.2%) displayed a decrease in NLR. Low pretreatment and post-treatment NLR levels (<5), high pretreatment and post-treatment LMR levels (≥4), reduction of post-treatment NLR and elevation of post-treatment LMR were associated with improved objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and OS. In multivariate regression analysis, the number of distant metastases, lines of immunotherapy, levels of pretreatment and post-treatment NLR and LMR were significantly associated with OS. We developed the "NLML" prognostic scoring system, which showed an area under the curve (AUC) of 0.775 (95% CI: 0.700-0.838, P <0.001) and reached its peak at 3 years (AUC=0.955, 95% CI: 0.909-0.982, P <0.001). Early dynamic alterations in NLR and LMR values from pre-treatment to post-treatment, along with individual pretreatment or post-treatment NLR or LMR levels, exhibited correlations with treatment outcomes in patients undergoing either mono-immunotherapy or chemoimmunotherapy. The "NLML" prognostic scoring system emerged as a practical and effective model for predicting survival within this patient population.