Background/Objectives:Immune-related adverse events (irAEs) triggered by immune checkpoint inhibitor therapy (ICI) have been paradoxically associated with both significant morbidity and improved cancer outcomes. While predictive markers for irAEs have been studied in the PD-1 blockade, less is known for their role in CTLA-4 inhibition. This study aims to fill this gap by evaluating NLR and irAE incidence in a CTLA-4-treated population.Methods:This study is a single-center retrospective cohort study investigating 111 patients treated with CTLA-4 inhibition (ipilimumab) to assess associations for baseline low NLR values with cancer outcomes and irAE type and incidence. Patient charts were manually reviewed by a single physician, and unclear clinical events were assessed by a second physician reviewer.Results:In this cohort, the occurrence of more than one irAE presentation was associated with an improved cancer outcome, OR 1.48 (1.02, 2.15). When stratified by organ-specific manifestation, only endocrinologic irAEs were associated with improved cancer outcome, OR 2.82 (1.19, 6.67). A low baseline NLR was statistically significantly associated with an increased incidence of irAEs of any type, OR 4.34 (1.73, 10.9).Conclusions:These data show that irAE occurrence in cancer patients treated with CTLA-4 inhibition is associated with improved cancer outcomes, similar to that previously seen with PD-1 inhibition. It also suggests that the NLR may serve as a practical peripheral biomarker to predict both cancer response and odds of irAEs in patients treated with CTLA-4 inhibition. This low-cost and widely available tool could provide additional information for modeling cancer outcomes.
背景/目的：免疫检查点抑制剂治疗引发的免疫相关不良事件，与显著的发病率和改善的癌症预后之间存在矛盾关联。虽然针对PD-1阻断治疗的irAE预测标志物已有研究，但关于其在CTLA-4抑制治疗中的作用尚不明确。本研究旨在通过评估CTLA-4治疗人群的中性粒细胞-淋巴细胞比值与irAE发生率，填补这一知识空白。 方法：本研究为单中心回顾性队列研究，纳入111例接受CTLA-4抑制剂（伊匹木单抗）治疗的患者，分析基线低NLR值与癌症预后及irAE类型、发生率之间的关联。患者病历由单一医师人工审阅，存疑临床事件由第二位医师复核评估。 结果：在该队列中，出现一种以上irAE表现与改善的癌症预后相关（OR 1.48，95%CI 1.02-2.15）。按器官特异性表现分层分析时，仅内分泌系统irAE与改善的癌症预后相关（OR 2.82，95%CI 1.19-6.67）。基线低NLR值与任何类型irAE发生率增加存在统计学显著关联（OR 4.34，95%CI 1.73-10.9）。 结论：本研究表明，接受CTLA-4抑制剂治疗的癌症患者发生irAE与改善的癌症预后相关，这与既往PD-1抑制剂研究中观察到的现象相似。同时提示NLR可能作为实用的外周血生物标志物，用于预测CTLA-4抑制剂治疗患者的癌症反应和irAE发生概率。这种低成本且广泛可得的检测工具可为癌症预后建模提供补充信息。
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