Pretreatment Neutrophil-to-Lymphocyte Ratio as a Prognostic Biomarker in Unresectable or Metastatic Esophageal Cancer Patients With Anti-PD-1 Therapy

<jats:sec><jats:title>Background</jats:title><jats:p>The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory index calculated by the absolute neutrophil count dividing the absolute lymphocyte count, and its prognostic role in esophageal cancer (EC) patients with anti-PD-1 therapy remains unclear.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A total of 140 unresectable or metastatic EC patients receiving PD-1 inhibitor treatment were included from Jan 2016 to Mar 2020. Kaplan–Meier method and log-rank test were used for comparing overall survival (OS) and progression-free survival (PFS) between groups. Multivariate Cox analysis was performed to assess the prognostic value of NLR.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The cutoff value of NLR was set at 5, and the median follow-up time was 20.0 months. Patients with pretreatment NLR &lt;5 had higher ORR (46.7% vs. 12.1%; <jats:italic>p</jats:italic> &lt; 0.001) and DCR (85.0% vs. 69.7%; <jats:italic>p</jats:italic> = 0.047) than those with NLR ≥5. Kaplan–Meier curves showed that pretreatment NLR &lt;5 was associated with longer PFS (median: 10.0 vs. 3.5 months, <jats:italic>p</jats:italic> &lt; 0.0001) and OS (median: 22.3 vs. 4.9 months, <jats:italic>p</jats:italic> &lt; 0.0001). Multivariate analysis demonstrated that pretreatment NLR ≥5 independently and significantly increased the risk of disease progression (hazard ratio (HR), 1.77 (95% confidence interval (CI), 1.12–2.82); <jats:italic>p</jats:italic> = 0.015) and death (HR, 4.01 (95% CI, 2.28–7.06); <jats:italic>p</jats:italic> &lt; 0.001). Subgroup analysis showed that pretreatment NLR ≥5 was associated with poor efficacy and survival in most subsets.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our findings showed that pretreatment NLR was independently and significantly associated with the efficacy and prognosis of EC patients treated with PD-1 inhibitors. NLR could serve as a convenient and useful prognostic biomarker for EC patients with anti-PD-1 therapy.</jats:p></jats:sec>