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Lee PY, Oen KQX, Lim GRS, Hartono JL, Muthiah M, Huang DQ, Teo FSW, Li AY, Mak A, Chandran NS, Tan CL, Yang P, Tai ES, Ng KWP, Vijayan J, Chan YC, Tan LL, Lee MBH, Chua HR, Hong WZ, Yap ES, Lim DK, Yuen YS, Chan YH, Aminkeng F, Wong ASC, Huang Y, Tay SH. Neutrophil-to-Lymphocyte Ratio Predicts Development of Immune-Related Adverse Events and Outcomes from Immune Checkpoint Blockade: A Case-Control Study. Cancers (Basel) 2021; 13:cancers13061308. [PMID: 33804050 PMCID: PMC8001500 DOI: 10.3390/cancers13061308] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
The utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) utility in predicting immune-related adverse events (irAEs) and survival have not been well studied in the context of treatment with immune checkpoint inhibitors (ICIs). We performed a case-control study of cancer patients who received at least one dose of ICI in a tertiary hospital. We examined NLR and PLR in irAE cases and controls. Logistic and Cox regression models were used to identify independent risk factors for irAEs, progression-free survival (PFS), and overall survival (OS). The study included 91 patients with irAEs and 56 controls. Multiple logistic regression showed that NLR < 3 at baseline was associated with higher occurrence of irAEs. Multivariate Cox regression showed that development of irAEs and reduction in NLR from baseline to week 6 were associated with longer PFS. Higher NLR values at baseline and/or week 6 were independently associated with shorter OS. A reduction in NLR from baseline to week 6 was associated with longer OS. In this study of cancer patients treated with ICIs, NLR has a bidirectional relationship with adverse outcomes. Lower NLR was associated with increased occurrence of irAEs while higher NLR values were associated with worse clinical outcomes.
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Affiliation(s)
- Pei Yi Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
| | - Kellynn Qi Xuan Oen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
| | - Grace Rui Si Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
| | - Juanda Leo Hartono
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Mark Muthiah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Daniel Q. Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Felicia Su Wei Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Andrew Yunkai Li
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Anselm Mak
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Nisha Suyien Chandran
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Chris Lixian Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Peiling Yang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Endocrinology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Kay Wei Ping Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Joy Vijayan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Yee Cheun Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Li Ling Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Department of Cardiology, National University Heart Center, National University Hospital, Singapore 119228, Singapore
| | - Martin Beng-Huat Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Horng Ruey Chua
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Wei Zhen Hong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Eng Soo Yap
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Department of Laboratory Medicine, National University Hospital, Singapore 119228, Singapore
| | - Dawn K. Lim
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (D.K.L.); (Y.S.Y.)
- Department of Ophthalmology, National University Hospital, Singapore 119228, Singapore
| | - Yew Sen Yuen
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (D.K.L.); (Y.S.Y.)
- Department of Ophthalmology, National University Hospital, Singapore 119228, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
| | - Folefac Aminkeng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
| | - Alvin Seng Cheong Wong
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore 119228, Singapore; (A.S.C.W.); (Y.H.)
| | - Yiqing Huang
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore 119228, Singapore; (A.S.C.W.); (Y.H.)
| | - Sen Hee Tay
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (P.Y.L.); (K.Q.X.O.); (G.R.S.L.); (J.L.H.); (M.M.); (D.Q.H.); (F.S.W.T.); (A.Y.L.); (A.M.); (N.S.C.); (C.L.T.); (P.Y.); (ES.T.); (K.W.P.N.); (J.V.); (Y.C.C.); (L.L.T.); (M.B.-H.L.); (H.R.C.); (W.Z.H.); (E.S.Y.); (F.A.)
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
- Correspondence:
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