Evidence map›Paper›PMID 42241716›Full record

ArticleRespirology (Carlton, Vic.)2026

Baseline Neutrophil-To-Lymphocyte Ratio as a Risk Stratification Marker for Severe Checkpoint Inhibitor Pneumonitis in Patients With Non-Small Cell Lung Cancer: A Two-Cohort Study With Retrospective Discovery and Prospective Validation.

Tetsu Hirakawa, Kakuhiro Yamaguchi, Shun Takao, Nobuhiro Kanaji, Naoko Matsumoto, Kozue Miyazaki, Tamio Okimoto, Chihiro Ando, Hisao Higo, Masaaki Yanai and 15 more

Abstract readValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Respirology (Carlton, Vic.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors.

Tetsu HirakawaDepartment of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.ORCID https://orcid.org/0009-0007-9091-3397
Kakuhiro YamaguchiDepartment of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan.ORCID https://orcid.org/0000-0002-9117-1934
Shun TakaoDepartment of Respiratory Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Nobuhiro KanajiDepartment of Internal Medicine, Division of Hematology, Rheumatology, and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Naoko MatsumotoDepartment of Respiratory Medicine, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan.
Kozue MiyazakiDepartment of Respiratory Medicine, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan.
Tamio OkimotoDepartment of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan.ORCID https://orcid.org/0000-0001-8295-1296
Chihiro AndoDepartment of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan.
Hisao HigoDepartment of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan.ORCID https://orcid.org/0000-0003-4946-0123
Masaaki YanaiDepartment of Respiratory Medicine and Rheumatology, Tottori University Hospital, Tottori, Japan.
Koji KuroseDepartment of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan.
Yasunari NagasakiDepartment of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan.
Masako WatanabeDepartment of Respiratory Medicine, Hiroshima City North Medical Care Asa Citizens Hospital, Hiroshima, Japan.
Kosuke OyamaDepartment of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan.
Yuko ToyodaDepartment of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi, Japan.
Yoshihiro TaguchiDepartment of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan.ORCID https://orcid.org/0000-0002-1417-9668
Shimpei TadaDepartment of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Kiyofumi ShimojiDepartment of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan.ORCID https://orcid.org/0000-0001-5382-4730
Shinjiro SakamotoDepartment of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan.
Yasushi HorimasuDepartment of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan.ORCID https://orcid.org/0000-0002-3390-8491
Takeshi MasudaDepartment of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan.ORCID https://orcid.org/0000-0003-3557-0049
Taku NakashimaDepartment of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.ORCID https://orcid.org/0000-0002-0035-674X
Hiroshi IwamotoDepartment of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.ORCID https://orcid.org/0000-0003-4922-5334
Hironobu HamadaDepartment of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Noboru HattoriDepartment of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Funding

Shino-Test Corporationthe AMED Translational Research Grant Seeds A
6 · The paper itself

Abstract

BACKGROUND AND

objectiveSevere checkpoint inhibitor pneumonitis (CIP), particularly when it develops within 6-12 weeks, is a potentially fatal adverse event in patients with non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs). Although neutrophil-to-lymphocyte ratio (NLR) has been reported to predict immune-related adverse events, its role in severe CIP remains unclear.

methodsThe discovery cohort retrospectively enrolled 102 patients with NSCLC treated with ICI monotherapy at Hiroshima University Hospital. The validation cohort prospectively enrolled 191 NSCLC patients receiving first-line treatment, including ICI, at 15 institutions. Severe CIP was defined as grade 3-5 pneumonitis occurring within 3 months of treatment initiation. The cut-off level of the baseline NLR was identified by receiver operating characteristic curve analysis in the discovery cohort, and the predictive accuracy was analyzed and confirmed in both cohorts.

resultsSevere CIP was observed in seven (6.9%) and 11 (5.8%) patients in the discovery and validation cohorts, respectively. In the discovery cohort, the baseline NLR was higher in patients with severe CIP than in those without (17.29 [4.76-20.73] vs. 3.70 [2.64-6.68], p = 0.006), and the cut-off level of the baseline NLR was set at 4.75 (AUC 0.81; sensitivity 85.7%, specificity 64.2%). The incidence of severe CIP was significantly higher in patients with higher baseline NLR levels (≥ 4.75) than in those without, in both cohorts (discovery: 15.0% vs. 1.6%, p = 0.009; validation: 10.3% vs. 3.3%, p = 0.046).

conclusionBaseline NLR is a promising risk stratification marker for severe CIP.

Indexed as

Carcinoma, Non-Small-Cell LungImmune Checkpoint InhibitorsLung NeoplasmsLymphocytesNeutrophilsPneumoniaAgedAged, 80 and overFemaleHumansLymphocyte CountMaleMiddle AgedProspective StudiesRetrospective StudiesRisk AssessmentImmune Checkpoint Inhibitorsbiomarkercheckpoint inhibitor pneumonitisimmune checkpoint inhibitorneutrophil‐to‐lymphocyte rationon‐small‐cell lung cancer

Identifiers

PMID42241716
PMCPMC13535713

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.