Predictive value of NLR and PLR for outcome after immunotherapy in advanced urothelial carcinoma

Abstract:

Objective To explore the value of peripheral blood neutrophil-to-lymphocyte ratio（NLR） and platelet-to-lymphocyte ratio（PLR） in predicting the outcome after immunotherapy for advanced urothelial carcinoma.Methods We retrospectively analyzed the clinical data of patients with advanced urothelial carcinoma treated with immune checkpoint inhibitors from September 2019 to July 2022. The patients were grouped according to the cut-off value derived from the area under the curve（AUC）. The Kaplan-Meier method was used to compare the survival of the groups. A multivariable Cox model was used to determine independent predictive factors.Results A total of 57 patients were included. After three cycles of immunotherapy，NLR was significantly decreased（pre-treatment 2.40±1.08 vs. post-treatment 3.05±1.07，P<0.001）. There was no significant change in PLR（pre-treatment 226.41±111.70 vs. post-treatment 246.97±113.17，P=0.402）. The AUC values of pre-NLR，post-NLR，pre-PLR，post-PLR，and delta-NLR（change in NLR） were 0.829 1（P=0.004），0.889 6（P<0.001），0.743 6（P=0.003），0.740 4（P<0.001），and 0.798 4（P<0.001），respectively. The survival analysis showed that pre-NLR ≥3.17（3.5 months vs. not achieved，P<0.001），pre-PLR≥284.40（5.7 months vs. 9.5 months，P=0.011），post-NLR ≥2.41（4.8 months vs. 9.9 months，P<0.001），and delta-NLR<19.8%（5.8 months vs. 9.5 months，P=0.004） were significantly associated with a poorer PFS；first-line immunotherapy combined with chemotherapy produced a better PFS（9.3 months vs. 6.0 months，P=0.006），and NLR change was significantly greater in patients with combined treatment（P=0.034）. The multivariable Cox analysis showed that pre-NLR，delta-NLR，and whether chemotherapy was combined were independent predictors of PFS after immunotherapy in advanced urothelial carcinoma（P<0.05）.Conclusion High levels of NLR and PLR before treatment indicate a poor prognosis. First-line immunotherapy combined with chemotherapy can reduce NLR and prolonging patients’ PFS. NLR and its change are independent predictors of outcome after immunotherapy in advanced urothelial carcinoma.