The neutrophil -to-lymphocyte ratio (NLR) is useful for predicting the effectiveness of treatment with immune checkpoint inhibitors (ICIs) and immune-related adverse events (irAEs). Because a growing body of evidence has recently shown that the number of lymphocytes that comprise NLR fluctuates according to nutritional status, this study examined whether the usefulness of NLR varies in ICI treatment due to changes in nutritional status. A retrospective analysis was performed on 1234 patients who received ICI treatment for malignant tumors at our hospital. Progression-free survival (PFS) was significantly prolonged in patients with NLR < 4. Multivariate analysis revealed that the factors associated with the occurrence of irAE were NLR < 4 and the use of ipilimumab. However, when limited to cases with serum albumin levels <3.8 g/dL, lymphocyte counts significantly decreased, and the associations between NLR and PFS and between NLR and irAE occurrence disappeared. In contrast, when limited to the cases with serum albumin levels ≥3.8 g/dL, the associations remained, with significantly prolonged PFS and significantly increased irAE occurrence at NLR < 4. NLR may be a good predictive tool for PFS and irAE occurrence during ICI treatment when a good nutritional status is maintained.
中性粒细胞与淋巴细胞比值（NLR）可用于预测免疫检查点抑制剂（ICIs）治疗的有效性及免疫相关不良事件（irAEs）的发生风险。鉴于近期多项证据表明，构成NLR的淋巴细胞数量会随营养状态波动，本研究探讨了NLR在ICI治疗中的预测价值是否会因营养状态变化而改变。我们对本院接受ICI治疗的1234例恶性肿瘤患者进行了回顾性分析。结果显示，NLR＜4的患者无进展生存期（PFS）显著延长。多变量分析表明，与irAE发生相关的因素包括NLR＜4及伊匹木单抗的使用。然而，当限定血清白蛋白水平＜3.8 g/dL的患者时，淋巴细胞计数显著下降，且NLR与PFS、NLR与irAE发生率之间的关联性消失。相反，在血清白蛋白水平≥3.8 g/dL的患者中，这些关联性仍然存在：NLR＜4时PFS显著延长，irAE发生率显著升高。研究表明，在维持良好营养状态的前提下，NLR可作为预测ICI治疗期间PFS及irAE发生风险的有效指标。
肿瘤(癌症)患者之家