Evaluating the prognostic significance of the pre-treatment neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios in 177Lu-DOTATATE PRRT treated patients with advanced metastatic neuroendocrine tumors

This is the authors' abstract. We don't add key points for this paper.

This study aimed to investigate the role of pre-treatment neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) in the prognosis assessment of 177 Lu-DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) treated patients with advanced metastatic neuroendocrine tumors (NETs). Eligible PRRT-treated patients (n = 247, 2010–2019) were included. Pre-PRRT NLR and MLR were calculated from complete blood count data. Data on tumor characteristics, response to PRRT, progression-free survival (PFS), and overall survival (OS) were evaluated using COXPH analyses. In NET patients, median values of NLR and MLR were 2.21 (IQR = 1.66–3.00) and 0.14 (IQR = 0.06–0.24), respectively. NLR showed significant positive association with G3 tumors (median = 3.64, IQR = 2.1–4.26, p = 0.022) and high 18 F-FDG avidity (SUVmax>5) (median = 2.5, IQR = 1.82–3.56, p = 0.003). MLR was significantly associated with high disease burden (median = 0.18, IQR = 0.08–0.29, p = 0.0083). MLR distinguished between the PRRT non-responders with progressive disease and responders with complete/partial response (median 0.19 versus 0.12, p = 0.043) or responders with stable disease (median 0.19 versus 0.14, p = 0.045). The ratios independently correlated with disease progression and OS. Patients in NLR high (>3.5) group displayed significantly shorter median PFS and OS (48 and 58 months) compared to NLR low (≤3.5) group (108 and 96 months) ( p < 0.01). Patients in MLR high (>0.25) group displayed significantly shorter median PFS and OS (40 and 52 months) compared to MLR low (≤0.25) group (108 and 102 months) ( p < 0.01). Pre-treatment NLR and MLR had an independent prognostic impact on disease progression and OS in PRRT-treated NET patients. This routine, inexpensive CBC-based test in the standard pre-PRRT workup demonstrates the prognostic value and may aid clinicians in the risk stratification of NET patients.