Low pre-treatment neutrophil-to-lymphocyte ratio predicted a better survival in recurrent/metastatic cervical cancer treated with PD-1/PD-L1 inhibitors

A precise predictor is urgently needed for immunotherapy in cervical cancer (CC), which would be very helpful for disease monitoring. Thus, we explore the relationship between pre-treatment neutrophil-to-lymphocyte ratio (NLR) and prognosis in recurrent/metastatic CC patients who were treated with PD-1/PD-L1 inhibitors. A total of 282 patients with recurrent/metastatic cervical cancer were enrolled in this retrospective study from December 2018 to September 2023. The area under the receiver operating characteristic (ROC) curve was used to identify the optimal threshold for evaluating the influence of pre-treatment NLR on patients' survival. Kaplan-Meier analysis was conducted to determine the predictive roles of pre-treatment NLR for progression-free survival of immunotherapy (PFSi) and overall survival (OS). A pre-treatment NLR = 3.91 was determined to be the optimal cut-off value for predicting patient prognosis, with an AUC of 0.636 (P < 0.05). Patients with a pre-treatment NLR < 3.91 (low-NLR group) exhibited significantly extended PFSi (P < 0.001) and OS (P < 0.001) compared to those with pre-treatment NLR ≥ 3.91 (high-NLR group). Notably, lower pre-treatment NLR was associated with better objective response rate (36.8% vs. 18.3%, P < 0.001). In the stratification analysis, the predictive roles of pre-treatment NLR were mainly found in patients with positive expression of PD-L1 (P = 0.041 for PFSi; P = 0.001 for OS). Moreover, regardless of when the immunotherapy was initiated, a lower pre-treatment NLR correlated with longer survival. The pre-treatment NLR could be a biomarker for predicting the response to anti-PD-1/PD-L1 therapy in recurrent/metastatic CC. In combination with PD-L1 status, it may improve the benefits of immunotherapy and lower the treatment costs.