The Predictive Value of Neutrophil‐To‐Lymphocyte Ratio ( NLR ) for Response to Neoadjuvant Immunochemotherapy in Resectable IIA – IIIB Non‐Small Cell Lung Cancer in Real‐World Practice

OBJECTIVE: A significant clinical challenge remains the identification of non-small cell lung cancer (NSCLC) patients who will derive maximum benefit from neoadjuvant immunochemotherapy. The neutrophil-to-lymphocyte ratio (NLR) may offer critical insights into the host's capacity to mount an effective anti-tumor response. METHODS: This retrospective study consecutively included patients with stage IIA-IIIB NSCLC who received 2-4 cycles of platinum-based immunochemotherapy prior to planned resection at the Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine from 2017 to 2022. RESULTS: A total of 317 patients were included in our study and divided into two groups according to the median baseline NLR (3.27) of the whole population: low NLR (< 3.27) group (160 patients) and high NLR (≥ 3.27) group (157 patients). The rate of MPR in the low NLR group was significantly higher than that in the high NLR group (58.3% vs. 38.5%, p = 0.008). The median PFS in the low NLR group was not reached and 21.6 months (95% confidence interval [CI], 16.9 to 26.3) in the high NLR group (hazard ratio [HR] for disease progression, disease recurrence, or death, 0.431; 95% CI, 0.312 to 0.594; p < 0.001). The median OS in the low NLR group was not reached and 33.2 months (95% CI, 18.8 to 47.6) in the high NLR group (HR for death, 0.416; 95% CI, 0.295 to 0.586; p < 0.001). CONCLUSIONS: A low pre-treatment NLR is a predictive marker of enhanced pathological response and improved survival outcomes in IIA-IIIB NSCLC patients undergoing neoadjuvant immunochemotherapy.