Background At present, biomarkers such as prevailing programmed cell death 1 ligand 1 (PD-L1) expression and microsatellite instability (MSI ) have been proposed as a way of predicting the outcome of immunotherapy in patients with advanced gastric cancer (AGC). However, there are still lack of effective biomarkers for recognizing the benefit group with AGC treatment.
Objective To explore the correlation between derived neutrophil‐to‐lymphocyte ratio (dNLR) and the prognosis of AGC patients with immune checkpoint inhibitors (ICIs).
Methods A total of 123 AGC patients receiving immunotherapy in the Department of Tumor Center, Chinese PLA General Hospital from December 2014 to November 2018 were enrolled. According to the major clinical research in foreign countries, 3 was selected as the cut-off value of dNLR. The difference in median OS and median PFS of AGC patients with different levels (low-level group and high-level group) of dNLR after immunotherapy was analyzed. Kaplan-Meier was used for univariate analysis, and Cox regression model was used for multivariate analysis.
Results Of the 123 AGC patients, there were 31 female patients and 92 male patients, with median age of 58 years old. The median OS was 9.4 months, and the median PFS was 3.8 months. Median PFS was 4.6 months in the dNLR high level group, and 2.6 months in the low level group (HR: 1.952, 95% CI: 1.248-3.053, P=0.008). The median OS was 11.2 months in the dNLR high level group, and 4.8 months in the low level group (HR: 0.59, 95% CI: 1.691-4.188, P＜0.001). No significant difference was found in ORR (25% vs 24.2%, P=0.932) and DCR (46.4% vs 48.4%, P=0.853) between the high and low dNLR groups.
Conclusion Our research shows that the level of dNLR before treatment is an independent biomarker for predicting PFS and OS after immunotherapy in AGC patients. Patients in dNLR low level group may benefit from ICIs.
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