Predictive value of derived neutrophil-to-lymphocyte ratio for immune checkpoint inhibitor outcomes in advanced gastric cancer

The derived neutrophil-to-lymphocyte ratio (dNLR) has been suggested as a potential prognostic biomarker for patients undergoing immune checkpoint inhibitor (ICI) therapy, particularly in advanced gastric cancer (AGC). This study aims to evaluate the prognostic value of pretreatment dNLR in AGC patients receiving ICIs. In this retrospective study, 168 AGC patients treated with ICIs at our hospital from January 2015 to December 2019 were included. Patients were grouped based on baseline dNLR levels: high (dNLR ≥ 3) and low (dNLR < 3). Treatment response was evaluated using the response evaluation criteria in solid tumors version 1.1, and progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier survival analysis. Statistical analyses included Cox proportional hazards regression and log-rank tests to determine the impact of dNLR on survival outcomes. A total of 168 patients with AGC were analyzed. Baseline characteristics were generally balanced between groups, with 22.6% of patients classified as high dNLR (≥3). Treatment response did not significantly differ according to dNLR status: objective response rate was 26.2% in the low dNLR group versus 23.7% in the high dNLR group, and disease control rate was 49.2% versus 44.8%, respectively. In contrast, survival outcomes showed significant differences. Patients with low dNLR had a markedly longer median OS (23.5 vs 15.6 months; hazard ratio = 1.865, 95% confidence interval: 1.216-3.156, P < .001) and median PFS (15.6 vs 8.5 months; hazard ratio = 1.916, 95% confidence interval: 1.213-3.028, P < .001) compared with those with high dNLR. Multivariate Cox regression adjusting for age, Eastern Cooperative Oncology Group score, metastatic burden, and treatment modality confirmed that high dNLR independently predicted poorer PFS and OS. Pretreatment dNLR is a valuable prognostic biomarker for PFS and OS in AGC patients receiving ICI therapy. Patients with lower dNLR levels may achieve more favorable outcomes, underscoring the potential of dNLR in guiding personalized treatment strategies for AGC.