ArticleFrontiers in oncology2026
Dynamic neutrophil-to-lymphocyte ratio as an independent prognostic marker of overall survival in patients receiving immune checkpoint inhibitors: a Latin American cohort study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive, routinely available marker of systemic inflammation that has been proposed as a prognostic biomarker in cancer immunotherapy. However, most evidence derives from single baseline measurements in selected populations, and the prognostic value of Methods: We retrospectively analyzed 68 patients with advanced solid tumors (lung, urological, melanoma, and others) treated with ICI at two Uruguayan institutions: Hospital de Clínicas, Universidad de la República, and Instituto Nacional del Cáncer (INCA), both in Montevideo, Uruguay. NLR and platelet-to-lymphocyte ratio (PLR) were measured at baseline and at each treatment cycle (up to 12 cycles). OS and progression-free survival were analyzed using Kaplan-Meier estimates and Cox proportional-hazards models, including a time-varying covariate model using serial NLR. Six-month RECIST response and immune-related adverse events were assessed as secondary outcomes. Robustness was evaluated with bootstrap confidence intervals, permutation testing, and correction for multiple comparisons. Results: Over a median follow-up of 16.8 months, 39 deaths occurred (survival population n=66). Elevated baseline NLR was associated with shorter OS (HR 1.18 per unit, 95% CI 1.04-1.34, p=0.011). In a time-varying analysis using serial measurements, higher on-treatment NLR remained independently associated with OS after adjustment for ECOG performance status (HR 1.09, 95% CI 1.00-1.19, p=0.040; ECOG p=0.021). Patients in the highest NLR quartile (>4.9) had markedly shorter median OS than the remainder of the cohort (7.3 vs ~25 months). Neither baseline nor dynamic NLR/PLR predicted six-month RECIST response. Combination anti-PD-1/anti-CTLA-4 therapy was associated with higher odds of immune-related toxicity (OR 5.03, p=0.023). Conclusions: In this real-world Latin American ICI cohort, dynamic on-treatment NLR was independently associated with overall survival, supporting serial monitoring of this inexpensive marker over single baseline assessment. NLR did not predict tumor response, underscoring that its prognostic value reflects systemic host condition rather than direct antitumor activity. These findings, though exploratory, support NLR trajectory as a low-cost prognostic adjunct warranting prospective validation. Since complete blood counts are already obtained at every treatment cycle for routine hematologic surveillance, this information could be captured at no additional cost to clinical practice.
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