Neutrophil-to-lymphocyte ratio and risk of disease progression in patients with nivolumab-treated unresectable or recurrent gastric cancer

Studies have associated neutrophil-to-lymphocyte ratio (NLR) with overall survival (OS) and progression-free survival (PFS) in patients with gastric cancer (GC). The present study aimed to examine the relationship between dynamic changes in NLR during treatment and disease progression in patients with unresectable or recurrent GC treated with nivolumab monotherapy as a third-line or later regimen. Patients treated with nivolumab as a third-line or later therapy for unresectable or recurrent GC at Gifu University Hospital (Gifu, Japan) from April 2017 to December 2021 were included. Pretreatment data and those obtained every 2 weeks after the treatment commenced were evaluated. The association between all NLR values and disease progression for each patient was evaluated using a time-dependent Cox proportional hazards model and restricted cubic spline (RCS) curves. The study included 44 patients (23 men and 21 women). The response and disease control rates were 6.8 and 27.3%, respectively. The median PFS and OS of all patients were 1.84 months [95% confidence interval (CI), 1.32-2.14] and 5.93 months (95% CI, 3.75-10.75), respectively. The risk for progressive disease (PD) increased with higher NLR (hazard ratio, 2.25; 95% CI, 1.3-3.87). The RCS curves also indicated that the higher the NLR, the higher the risk for PD, especially if the NLR value was <3.0. NLR during treatment could predict the risk of PD, suggesting that NLR could be integrated with tumor markers, computed tomographic images and other modalities to enable treatment selection without delay.