Real world outcomes in advanced urothelial cancer and the role of neutrophil to lymphocyte ratio.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16020-e16020
Author(s):  
Steven Yip ◽  
Jeenan Kaiser ◽  
Haocheng Li ◽  
Scott A. North ◽  
Daniel Yick Chin Heng ◽  
...  
Keyword(s):  
Real World ◽  
Cox Regression ◽  
Response Rates ◽  
Neutrophil To Lymphocyte Ratio ◽  
Second Line ◽  
First Line ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Line Setting

e16020 Background: Advanced urothelial carcinoma (UC) patients have a poor prognosis. In the first and second line UC treatment setting, we investigated real world outcomes and evaluated the prognostic role of the neutrophil to lymphocyte ratio (NLR). Methods: A retrospective analysis was performed on advanced UC patients treated with systemic therapy. Overall response rates (ORR), time to treatment failure (TTF) and overall survival (OS) were calculated. Cox regression analysis was performed to examine the association between baseline NLR (low NLR<3 vs high NLR≥3) and TTF and OS. Results: We evaluated 233 advanced UC patients. In the first line setting, the ORR was 25%. Median TTF and OS were 6.9 mo and 9 mo, respectively. Low baseline NLR was significantly associated with improved 8.3 mo median TTF, versus 5.8 mo for high NLR patients (p=0.05). Low NLR was significantly correlated with a longer median OS of 13.1 mo, in comparison to 8.2 mo in patients with high NLR (p=0.007). In the second line, an ORR of 22%, a median TTF of 4.1 mo and a median OS of 8 mo were observed. Low NLR in the second line was significantly associated with improved median TTF at 7.9 mo, versus 3.6 mo for patients with high NLR (p=0.03). Second line low NLR was also significantly associated with a longer median OS of 12.2 mo, in comparison to 6.8 mo in patients with high NLR (p=0.003). Conclusions: In this real world analysis of advanced UC patients, first line outcomes were lower than expected, while response rates in the second line compared favorably to the literature, suggesting a highly selected patient population actually receives second line treatment. A low baseline NLR in the first and second line is associated with improved TTF and OS and warrants further prospective evaluation. [Table: see text]

Second-line VEGF TKI after IO combination therapy: Results from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 684-684
Author(s):  
Igor Stukalin ◽  
Shaan Dudani ◽  
Connor Wells ◽  
Chun Loo Gan ◽  
Sumanta K. Pal ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Combination Therapy ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Cox Regression ◽  
Response Rates ◽  
Second Line ◽  
First Line ◽  
Cox Regression Analysis

684 Background: Immuno-Oncology (IO) combinations are standard of care first-line treatment for metastatic renal cell carcinoma (mRCC). Data on therapy with vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKI) post-progression on IO-combination therapy are limited. Methods: Using the IMDC, a retrospective analysis was done on mRCC patients treated with second-line VEGF TKIs after receiving IO combination therapy. Patients received first-line ipilimumab+nivolumab (IOIO) or anti-PD(L)1+anti-VEGF (IOVE). Baseline variables and second-line IMDC risk factors were collected. Overall response rates (ORR), time to treatment failure (TTF) and overall survival (OS) were determined. Multivariable Cox regression analysis was performed. Results: 142 patients were included. 75 patients received IOIO and 67 received IOVE pretreatment. The ORR of 2nd line therapy was 17/46 (37%) and 7/57 (12%) in the IOIO and IOVE pretreated groups, respectively (p<0.01). 2nd-line TTF was 5.4 months (95% CI 4.1-8.3) for the IOIO- and 4.6 months (95% CI 3.7-5.8) for the IOVE-pretreated group (p=0.37). 2nd-line median OS was 17.2 months (95% CI 10.8-35.1) and 11.8 months (95% CI 9.9-21.3) for the prior IOIO and IOVE groups, respectively (p=0.13). The hazard ratio adjusted by IMDC for IOVE vs IOIO pretreatment was 1.22 (95% CI 0.73-2.07, p=0.45) for 2nd line TTF and 1.43 (95% CI 0.74-2.8, p=0.29) for 2nd line OS. Conclusions: VEGF TKIs show activity after combination IO therapy. Response rates are higher in patients treated with VEGF TKIs after first-line IOIO compared to after IOVE. In patients with VEGF TKI after IOIO or IOVE, no difference in OS and TTF was observed.[Table: see text]

scholarly journals The Prognostic Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 343
Author(s):  
Jing-Houng Wang ◽  
Yen-Yang Chen ◽  
Kwong-Ming Kee ◽  
Chih-Chi Wang ◽  
Ming-Chao Tsai ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Objective Response ◽  
Progression Free Survival ◽  
Neutrophil To Lymphocyte Ratio ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Lymphocyte Ratio ◽  
Third Line

Atezolizumab plus bevacizumab has been approved as the first-line systemic treatment for patients with unresectable hepatocellular carcinoma (uHCC). This study was designed to assess the clinical impact of atezolizumab plus bevacizumab in uHCC patients. A total of 48 uHCC patients receiving atezolizumab plus bevacizumab were identified, including first-line, second-line, third-line, and later-line settings. In these patients, the median progression-free survival (PFS) was 5.0 months, including 5.0 months for the first-line treatment, not reached for the second-line treatment, and 2.5 months for the third line and later line treatment. The objective response rate and disease control rate to atezolizumab plus bevacizumab were 27.1% and 68.8%, respectively. The severity of most adverse events was predominantly grade 1–2, and most patients tolerated the toxicities. The ratios of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) were used to predict PFS in these patients. The optimal cutoff values of NLR and PLR were 3 and 230, and NLR and PLR were independent prognostic factors for superior PFS in the univariate and multivariate analyses. Our study confirms the efficacy and safety of atezolizumab plus bevacizumab in uHCC patients in clinical practice and demonstrates the prognostic role of NLR and PLR for PFS in these patients.

Elevation of Neutrophil-to-Lymphocyte Ratio before First-Line Chemotherapy Predicts a Poor Prognosis for Second-Line Chemotherapy in Gastric Cancer

Oncology ◽  
2018 ◽  
Vol 96 (3) ◽  
pp. 140-146 ◽  
Author(s):  
Dai Inoue ◽  
Shuhei Sekiguchi ◽  
Wataru Yamagata ◽  
Gen Maeda ◽  
Daiki Yamada ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Poor Prognosis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Second Line ◽  
First Line ◽  
Lymphocyte Ratio ◽  
Second Line Chemotherapy ◽  
Line Chemotherapy

scholarly journals Combination of Tertiary Lymphoid Structure and Neutrophil-to-Lymphocyte Ratio Predicts Survival in Patients With Hepatocellular Carcinoma

2022 ◽  
Vol 12 ◽  
Author(s):  
Shaodi Wen ◽  
Yuzhong Chen ◽  
Chupeng Hu ◽  
Xiaoyue Du ◽  
Jingwei Xia ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Inflammation ◽  
Cox Regression ◽  
Primary Liver Cancer ◽  
Paraffin Section ◽  
Neutrophil To Lymphocyte Ratio ◽  
Survival Prediction ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Inflammation Parameters

BackgroundHepatocellular carcinoma (HCC) is the most common pathological type of primary liver cancer. The lack of prognosis indicators is one of the challenges in HCC. In this study, we investigated the combination of tertiary lymphoid structure (TLS) and several systemic inflammation parameters as a prognosis indicator for HCC.Materials and MethodsWe retrospectively recruited 126 postoperative patients with primary HCC. The paraffin section was collected for TLS density assessment. In addition, we collected the systemic inflammation parameters from peripheral blood samples. We evaluated the prognostic values of those parameters on overall survival (OS) using Kaplan-Meier curves, univariate and multivariate Cox regression. Last, we plotted a nomogram to predict the survival of HCC patients.ResultsWe first found TLS density was positively correlated with HCC patients’ survival (HR=0.16, 95% CI: 0.06 − 0.39, p &lt; 0.0001), but the power of TLS density for survival prediction was found to be limited (AUC=0.776, 95% CI:0.772 − 0.806). Thus, we further introduced several systemic inflammation parameters for survival analysis, we found neutrophil-to-lymphocyte ratio (NLR) was positively associated with OS in univariate Cox regression analysis. However, the combination of TLS density and NLR better predicts patient’s survival (AUC=0.800, 95% CI: 0.698-0.902, p &lt; 0.001) compared with using any single indicator alone. Last, we incorporated TLS density, NLR, and other parameters into the nomogram to provide a reproducible approach for survival prediction in HCC clinical practice.ConclusionThe combination of TLS density and NLR was shown to be a good predictor of HCC patient survival. It also provides a novel direction for the evaluation of immunotherapies in HCC.

Predictive role of peritumoral CD3+ infiltration and neutrophil to lymphocyte ratio on overall survial in pateints affected by colorectal liver metastases treated with chemotherapy and surgery.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. 27-27
Author(s):  
Matteo Cimino ◽  
Matteo Donadon ◽  
Domenico Mavilio ◽  
Luca Di Tommaso ◽  
Massimo Roncalli ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Protective Factor ◽  
Cox Regression ◽  
Absolute Lymphocyte Count ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Markers Of Inflammation

27 Background: Systemic and local inflammation plays an important role in many cancers and colorectal liver metastases (CRLM). While the role of local immune response mediated by CD3+ tumour infiltrating lymphocyte is well established new evidence on systemic inflammation and cancer such as neutrophil–lymphocyte ratio (NLR) are emerging. The aim of the study is to associate these two markers of inflammation to predict overall survival (OS) in patients affected by CRLM. Methods: From January 2006 to January 2013 128 consecutive patients affected by CRLM treated with chemotherapy and surgery were included in the study. CD3+ peritumoral infiltration was defined as the ratio of intra-tumoural\invasive-margin CD3+ infiltration evaluated with immunohistochemistry on CRLM tumor slides. NLR was calculated as neutrophil absolute count divided by the absolute lymphocyte count on blood sample. ROC curves were used to calculate a cut-off for each bio-markers related to OS . Associating the bio-markers two risk groups were determined: low risk (LRG) two protective bio-markers; high risk (HRG) no protective bio-markers. Results: After a median follow-up of 45 months, median OS was 44 months.Twenty-nine patients (22.6%) belong to the LRG whereas 99 patients (77,4) belong to HRG. Adjusted Cox regression analysis showed a worse OS for HRG patients (HR 2.74 p = 0.003 95%CI 1.40-5.37). Median OS was 80.8 vs 42.5 months for LRG vs HRG respectively. Conclusions: High CD3+ peritumoural infiltration associated with low NRL are two protective factor on OS for patients affected by CRLM.

scholarly journals Neutrophil to Lymphocyte Ratio as Prognostic Indicator for Patients with Esophageal Squamous Cell Cancer

2017 ◽  
Vol 32 (4) ◽  
pp. 409-414 ◽  
Author(s):  
Guo-Dong Gao ◽  
Bo Sun ◽  
Xian-Bin Wang ◽  
Shi-Meng Wang
Keyword(s):  
Overall Survival ◽  
Squamous Cell ◽  
Cox Regression ◽  
Cell Cancer ◽  
Prognostic Indicator ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Leukocyte Counts ◽  
Clinical Records

Background This study aimed to evaluate the correlation between neutrophil to lymphocyte ratio (NLR) with overall survival (OS) of esophageal squamous cell carcinoma (ESCC) patients. Method Records of patients with diagnosed ESCC were reviewed. Leukocyte counts and patients' characteristics were extracted from their clinical records to calculate NLR. Correlation between NLR and baseline characteristics with overall survival (OS) was then analyzed using Cox regression. The patients were then separated into higher and lower NLR groups according to median NLR. OS was further compared between the 2 groups. Results A total of 1281 patients were included in the study. Cox regression analysis showed a significant correlation of NLR with OS of ESCC patients. The median pretreatment NLR was identified as 2.86. Higher NLR was associated with worse prognosis in terms of OS. Conclusions Pretreatment NLR is independently associated with OS of ESCC patients. Therefore, NLR may be used as a predictive indicator for pretreatment evaluation and adjustment of treatment regimen.

scholarly journals Neutrophil to Lymphocyte Ratio Predicts Adverse Cardiovascular Outcome in Peritoneal Dialysis Patients Younger than 60 Years Old

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Yingsi Zeng ◽  
Zijun Chen ◽  
Qinkai Chen ◽  
Xiaojiang Zhan ◽  
Haibo Long ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cox Regression ◽  
Neutrophil To Lymphocyte Ratio ◽  
Forest Plot ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Increased Risk ◽  
The Relationship ◽  
Cvd Mortality ◽  
New Onset

Background. Neutrophil to lymphocyte ratio (NLR) is a new inflammatory marker; the relationship between NLR and adverse cardiovascular (CV) prognosis has been gradually emphasized in the general population. However, their association in peritoneal dialysis (PD) patients remains unclear. Methods. From January 1, 2010, to May 31, 2017, a total of 1652 patients were recruited. NLR was categorized in triplicates: NLR≤2.74, 2.74<NLR≤3.96, and NLR>3.96. Kaplan-Meier cumulative incidence curve and multivariable COX regression analysis were used to determine the relationship between NLR and the incidence of adverse CV outcome, while a competitive risk model was applied to assess the effects of other outcomes on adverse CV prognosis. Besides, forest plot was investigated to analyze the adverse CV prognosis in different subgroups. Results. During follow-up, 213 new-onset CV events and 153 CV disease (CVD) deaths were recorded. Multivariable COX regression models showed that the highest tertile of NLR level was associated with increased risk of CV events (HR=1.39, 95%CI=1.01‐1.93, P=0.046) and CVD mortality (HR=1.81, 95%CI=1.22‐2.69, P=0.003), while compared to the lowest tertile. Competitive risk models showed that the differences in CV event (P<0.001) and CVD mortality (P=0.004) among different NLR groups were still significant while excluding the effects of other outcomes. In subgroups, with each 1 increased in the NLR level, adjusted HR of new-onset CV event was 2.02 (95%CI=1.26−3.23, P=0.003) and CVD mortality was 2.98 (95%CI=1.58−5.62, P=0.001) in the younger group (age<60 years). Conclusions. NLR is an independent risk factor for adverse CV prognosis in PD patients younger than 60 years old.

Checkpoint inhibitors in metastatic renal cell carcinoma patients including elderly subgroups: Results from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4580-4580
Author(s):  
Steven Yip ◽  
Connor Wells ◽  
Raphael Brandao Moreira ◽  
Alex Wong ◽  
Sandy Srinivas ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Real World ◽  
Renal Cell ◽  
Cox Regression ◽  
Cell Cancer ◽  
Second Line ◽  
Cox Regression Analysis ◽  
Poor Risk

4580 Background: Immuno-oncology (IO) checkpoint inhibitor treatment outcomes are poorly characterized in the real world metastatic renal cell cancer (mRCC) patient population, including geriatric patients. Methods: Using the IMDC database, a retrospective analysis was performed on mRCC patients treated with IO, as listed below. Patients received one or more lines of IO therapy, with or without a targeted agent. Duration of treatment (DOT) and overall response rates (ORR) were calculated. Cox regression analysis was performed to examine the association between age as a continuous variable and DOT. Results: 312 mRCC patients treated with IO were included. In patients who were evaluable, ORR to IO therapy was 29% (32% first-, 22% second-, 33% third-, and 32% fourth-line treatment (Tx)). Patients treated with second-line IO therapy were divided into favorable, intermediate, and poor risk using IMDC criteria; the corresponding median DOT rates were not reached (NR), 8.6 mo, and 1.9 mo, respectively (p<0.0001). Based upon age, hazard ratios were calculated in the first- through fourth-line therapy setting, ranging from 1.03 to 0.97. Conclusions: The ORR to IO appears to remain consistent, regardless of line of therapy. In the second-line, IMDC criteria appear to appropriately stratify patients into favorable, intermediate, and poor risk groups for DOT. Premature OS data will be updated. In contrast to clinical trial data, longer DOT is observed in real world practice. Age may not be a factor influencing DOT. [Table: see text]

Prognostic value of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 551-551 ◽  
Author(s):  
Jae Hyun Kim ◽  
Seun Ja Park
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Value ◽  
Cox Regression ◽  
Neutrophil To Lymphocyte Ratio ◽  
Platelet To Lymphocyte Ratio ◽  
Poor Overall Survival ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Kaplan Meier ◽  
Independent Risk Factors

551 Background: Inflammatory response plays an important role in the pathogenesis of cancer. Some evidence has suggested that elevations in the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with decreased survival in various types of cancer. In this study, we aimed to evaluate the prognostic value of the NLR and PLR in patients with colorectal cancer (CRC). Methods: Between August 1995 and December 2010, medical records from a total of 2,004 patients with CRC were retrospectively reviewed. The values of simple inflammatory markers including NLR and PLR in predicting the long-term outcomes of these patients were evaluated using Kaplan-Meier curves and multivariate Cox regression models. Results: The median follow-up duration was 42 months (interquartile range, 19 – 69). The estimation of NLR and PLR was based on the time of diagnosis. In multivariate Cox regression analysis, high NLR ( ≥ 2.6) [hazard ratio (HR) 2.251, 95% confidence interval (CI) 1.570-3.228, p < 0.001] and high PLR ( ≥ 155) [HR 1.473, 95% CI 1.019 – 2.128, p = 0.039] were independent risk factors predicting poor overall survival (OS) in CRC patients. Combined high NLR and PLR was also an independent risk factor predicting poor OS in patients with CRC [HR 2.316, 95% CI 1.529 – 3.508, p < 0.001]. Conclusions: In this study, we identified that high NLR ( ≥ 2.6), high PLR ( ≥ 155), and combined high NLR and PLR are useful prognostic factors to predict OS in CRC patients.

The impact of PBRM1 mutations on overall survival in greater than 2,100 patients treated with immune checkpoint blockade (ICB).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 666-666 ◽  
Author(s):  
A. Ari Hakimi ◽  
Yasser Ged ◽  
Jessica Flynn ◽  
Douglas R Hoen ◽  
Renzo G Di Natale ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Second Line ◽  
Loss Of Function ◽  
First Line ◽  
Vegf Inhibitors ◽  
Cell Renal Cell Carcinoma ◽  
Cox Regression Analysis ◽  
The Impact

666 Background: PBRM1 is the second most commonly mutated gene in clear cell renal cell carcinoma (ccRCC). We have previously shown favorable outcomes in PBRM1-mutated ccRCC tumors treated with vascular endothelial growth factor (VEGF) inhibitors. Recent data suggested PBRM1 mutations may sensitize ccRCC and non RCC malignancies to ICB therapy. We queried the impact of PBRM1 loss on overall survival (OS) across 2,152 patients treated with ICB. Methods: PBRM1 mutations were assessed in metastatic ccRCC patients who received first line (n = 82) or second line (n = 61) ICB or ICB/VEGF combinations. Additionally, 41 cohorts of non-RCC malignancies treated with ICB and combination (n = 2,009) were analyzed. Mutations were assessed by next generation targeted sequencing using archival tissue. Association of mutation status and overall survival (OS) was tested by multivariate Cox regression analysis (MVA) and adjusted for tumor mutation burden (TMB), copy number alterations (CNA), loss of function(LOF) mutations (non RCC cohort) and IMDC risk (for ccRCC patients). Results: PBRM1 mutations were not associated with improved OS in ICB the entire ccRCC cohort (HR 1.37; CI 0.79-2.4; p = 0.265), the first line (p = 0.624) or second line setting (p = 0.39) or as combination with VEGF inhibitors (p = 0.2). Several RCC subgroups were investigated (see Table at bottom). In the non-RCC cohorts (n = 2,009) PBRM1 mutations were not significantly associated with OS on univariate analysis (HR = 0.73, p = 0.22 for LOF and HR = 0.84,p = 0.34 for non LOF), and remained insignificant after adjusting for TMB, total CNA, and drug class (CTLA4, PD-1/PDL-1 and combinations) (HR = 1.07, p = 0.78 for LOF and HR = 1.08,p = 0.67 for non LOF). Conclusions: Neither in ccRCC nor in the pan-cancer cohort did PBRM1 mutations appear to be associated with improved overall survival with ICB therapy.[Table: see text]

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