ArticleJournal for immunotherapy of cancer2021
Low peripheral blood derived neutrophil-to-lymphocyte ratio (dNLR) is associated with increased tumor T-cell infiltration and favorable outcomes to first-line pembrolizumab in non-small cell lung cancer.
Article in Journal for immunotherapy of cancer, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 81 papers, 2 of them syntheses that pooled it.
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Who cites it
81 citing papers in PubMed, 2 syntheses or guidelines pooled it, 94 citations in OpenAlex.
- Pretreatment neutrophil-to-lymphocyte ratio is associated with immunotherapy efficacy in patients with advanced cancer: a systematic review and meta-analysis.Scientific reports · 2025Pooled it
- Prognostic value of baseline LIPI, LDH and dNLR in ES-SCLC patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis.Frontiers in immunology · 2025Pooled it
- Fruquintinib plus sintilimab in previously bevacizumab-treated, pMMR/MSS refractory metastatic colorectal cancer: a phase 2 clinical trial.Cancer immunology, immunotherapy : CII · 2025Trial
- Biomarkers of pembrolizumab efficacy in advanced anal squamous cell carcinoma: analysis of a phase II clinical trial and a cohort of long-term responders.Journal for immunotherapy of cancer · 2024Trial
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- Article
- Importance of the delivery route for the tolerability and efficacy of immunomodulatory agents for lung cancer.Scientific reports · 2026Article
- Circulating low-density neutrophils as biomarkers of resistance to first-line anti-PD-1/PD-L1 immunotherapy in non-small cell lung cancer.Translational oncology · 2026Article
- Peripheral Blood Biomarkers Predict Outcomes in Advanced Cancers Treated With Anti-PD-1 Therapy.Immunity, inflammation and disease · 2026Article
- Prognostication of non-small cell lung cancer with concurrent chemoradiation treatment using neutrophil-to-lymphocyte ratio.Radiation oncology journal · 2026Article
- Peripheral blood lymphocyte and eosinophil dynamics with chemotherapy and pembrolizumab in cervical cancer.International journal of clinical oncology · 2026Article
- Expert consensus on the detection and clinical application of tumor mutational burden.Cancer biology & medicine · 2026Article
- Prognostic Significance of Lung Immune Prognostic Index at Diagnosis in Stage III Non-Small Cell Lung Cancer.Current oncology (Toronto, Ont.) · 2026Article
- Tumor-associated neutrophils in lung adenocarcinoma: from mechanisms to therapeutic targeting.Frontiers in immunology · 2026Review
- Optimizing immunotherapy in advanced gastric cancer: established and emerging biomarkers for precision patient selection.Frontiers in immunology · 2026Review
- Dynamic inflammatory biomarkers as prognostic indicators in advanced breast cancer patients receiving PD-1 inhibitors.Therapeutic advances in medical oncology · 2026Article
- Safety and efficacy of PRaG therapy in elderly cancer patients.Immunotherapy advances · 2026Article
- Diagnostic Potential of New Systemic Inflammation Markers (MLR, SIRI, CAR, dNLR, ALB/dNLR) in Predicting the Severity of Pathogenic Signs of Rheumatoid Arthritis.Sovremennye tekhnologii v meditsine · 2026Article
- Host-related Determinants of Response to Immunotherapy in Non-small Cell Lung Cancer: The Interplay of Body Composition, Metabolism, Sex and Immune Regulation.Current oncology reports · 2025Review
- Enhancing prognostic precision: exploring the role of lung immune prognostic index in immunotherapy-treated soft tissue sarcoma patients-a retrospective study.Journal of orthopaedic surgery and research · 2025Article
21 more citing papers are in PubMed but not listed here.
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16 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundAn elevated peripheral blood derived neutrophil-to-lymphocyte ratio (dNLR) is a negative prognostic marker for patients with non-small cell lung cancer (NSCLC) receiving chemotherapy and immune checkpoint inhibitors. Whether dNLR is also associated with clinical outcomes to first-line pembrolizumab among patients with NSCLC and a programmed cell death ligand 1 (PD-L1) Tumor Proportion Score (TPS) of ≥50% is uncertain. How dNLR relates to the tumor immune microenvironment is also unclear.
methodsIn two participating academic centers, we retrospectively analyzed the dNLR (defined as the absolute neutrophil count/white cell count - absolute neutrophil count) prior to initiation of first-line pembrolizumab in patients with metastatic NSCLC and a PD-L1 TPS ≥50% and lacking genomic alterations in
resultsA total of 221 patients treated with first-line pembrolizumab were included in this study. The optimal dNLR cut-off to differentiate treatment responders from non-responders was 2.6. Compared with patients with a dNLR ≥2.6 (n=97), patients with dNLR <2.6 (n=124) had a significantly higher ORR (52.4% vs 24.7%, p<0.001), a significantly longer median progression-free survival (mPFS 10.4 vs 3.4 months, HR 0.48, 95% CI 0.35 to 0.66, p<0.001), and a significantly longer median overall survival (mOS 36.6 vs 9.8 months, HR 0.34, 95% CI 0.23 to 0.49, p<0.001). After adjusting for age, sex, tobacco use, performance status, histology, serum albumin level, oncogenic driver status, and PD-L1 distribution (50%-89% vs ≥90%), a dNLR <2.6 was confirmed to be an independent predictor of longer mPFS (HR 0.47, 95% CI 0.33 to 0.67, p<0.001) and mOS (HR 0.32, 95% CI 0.21 to 0.49, p<0.001). Among advanced NSCLC samples with a PD-L1 TPS of ≥50%, those with a dNLR <2.6 had significantly higher numbers of tumor-associated CD8+, FOXP3+, PD-1 +immune cells, and PD-1 +CD8+T cells than those with a dNLR ≥2.6.
conclusionsAmong patients with NSCLC and a PD-L1 TPS ≥50%, a low dNLR has a distinct immune tumor microenvironment and more favorable outcomes to first-line pembrolizumab.
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