ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1616477
This article is part of the Research TopicAdvancements and Challenges in Blood-Based Biomarkers for Cancer ImmunotherapyView all 3 articles
Performance of the neutrophil-to-lymphocyte ratio as a prognostic tool for survival in solid cancers
Provisionally accepted
- University of Washington, Seattle, United States
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Neutrophils and lymphocytes are crucial players in cancer progression, with the neutrophil-tolymphocyte ratio (NLR) emerging as a potential prognostic biomarker. However, its clinical relevance remains uncertain. This study retrospectively analyzed individual patient data from five Phase III clinical trials encompassing multiple cancer types to assess the prognostic value of baseline neutrophil (N1), lymphocyte (L1), and NLR (NLR1) counts for overall survival (OS) and progression-free survival (PFS). Survival outcomes were evaluated using Kaplan-Meier analyses, Cox proportional hazards models, and receiver operating characteristic curves, with subgroup analyses conducted across demographic and clinical subpopulations.High NLR1 and N1 and low L1 were associated with worse OS and PFS. In Cox uni-and multivariate analyses, NLR1 was an independent predictor of OS (HR: 1.508 (95% CI: 1.390 -1.636, p<0.001)), while N1 and L1 were only significant when analyzed categorically (N1 HR: 1.390, L1 HR: 0.801; all p < 0.001). Similar patterns were observed for PFS (NLR1 HR: 1.261, N1 HR: 1.154, L1 HR: 0.848; all p < 0.001). Biomarkers showed higher HR in < 60 years, Non-White, Stage IV, ECOG PS 1 patients.Kaplan-Meier analysis confirmed worse survival for most patients with highest NLR/N and low L.These findings confirm the prognostic role of blood cell components in cancer risk assessment and underscore the importance of personalized biomarker-based stratification, warranting further prospective studies to establish standardized clinical use.
Keywords: Survival, prognosis, biomarkers, Blood cell components, Cancer
Received: 22 Apr 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Carrión-Barberà and Lood. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Irene Carrión-Barberà, University of Washington, Seattle, United States
Christian Lood, University of Washington, Seattle, United States
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