Neutrophil-to-Lymphocyte Ratio Dynamics and Progression-Free Survival in Advanced Cutaneous Squamous Cell Carcinoma Treated With Cemiplimab

IF 3.4 4区医学 Q1 DERMATOLOGY

Dermatologic Therapy Pub Date : 2026-04-08 DOI:10.1155/dth/8309058

Irina Ciobotariu, Lucia Di Nardo, Alessandro Di Stefani, Andrea Paradisi, Maria Mannino, Francesco Brunetti, Ketty Peris

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Abstract

Background

Patients with locally advanced (la) and metastatic (m) cutaneous squamous cell carcinoma (CSCC) for which curative surgery or radiation is not available may benefit from treatment with anti–programmed cell death 1 (PD-1) monoclonal antibody cemiplimab. The predictive and prognostic role of hematological markers in such patients remains unclear.

Type of Study

A real-life retrospective cohort study was conducted to evaluate the role of hematological inflammatory parameters as predictive and prognostic factors in patients with laCSCC and mCSCC who underwent first-line treatment with cemiplimab.

Methods

Lymphocyte–monocyte ratio (LMR), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), albumin, creatinine, systemic immune–inflammation index (SII), and LDH were measured prior to cemiplimab therapy and subsequently at the first follow-up visit. To evaluate independent prognostic factors, the 12-month time-dependent performance was assessed using the incident/dynamic receiver operating characteristic (ROC) framework implemented with a nearest-neighbor estimator. Model performance metrics, including Harrell’s C-index and the time-dependent area under the curve (AUC), were quantified with 95% confidence intervals.

Results

A total of 43 CSCC patients including 37 (86.1%) with laCSCC and 6 (14.0%) with mCSCC were retrospectively enrolled. After a median of 33.1 weeks (8.4 months) of exposure to cemiplimab, ORR was 72% (31/43), including 41.9% (13/31) complete responses and 58.1% (18/31) partial responses; stable disease was observed in 9.7% (3/31). The median progression-free survival (PFS) was 6.4 months (IQR, 3.9–14.7 months). Overall, 7% of patients discontinued therapy due to adverse events (Grade 3 renal insufficiency and liver toxicity).

We identified a significant inverse association between NLR change from baseline to first on-treatment visit (ΔNLR) and PFS (Coeff = −0.25; 95% CI [jackknife] = −0.45–0.05, p = 0.014), showing higher ΔNLR score in patients with shorter PFS. The ΔNLR was associated with a 36% higher chance of progression (HR = 1.36, 95% CI = 0.97–1.89, p = 0.073), adjusted for age, systemic inflammatory index, and sex. Decision curve analysis showed a modest net benefit of the ΔNLR-based model across a broad range of threshold probabilities (approximately 7%–49%), without identification of a clinically optimal decision threshold.

Conclusion

Our study suggests that ΔNLR may serve as an exploratory prognostic indicator in patients with laCSCC and mCSCC.

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中性粒细胞与淋巴细胞的比率动态和无进展生存在晚期皮肤鳞状细胞癌用塞米单抗治疗

背景：局部晚期（la）和转移性(m)皮肤鳞状细胞癌（CSCC）患者，如果无法进行手术或放疗治疗，可能会从抗程序性细胞死亡1 （PD-1）单克隆抗体cemiplimab治疗中获益。血液学标志物在此类患者中的预测和预后作用尚不清楚。研究类型进行了一项真实的回顾性队列研究，以评估血液学炎症参数作为laCSCC和mCSCC患者接受西米单抗一线治疗的预测和预后因素的作用。方法在治疗前及第一次随访时测定各组患者淋巴细胞-单核细胞比（LMR）、中性粒细胞-淋巴细胞比（NLR）、血小板-淋巴细胞比（PLR）、白蛋白、肌酐、全身免疫炎症指数（SII）、LDH。为了评估独立的预后因素，使用事件/动态接收者工作特征（ROC）框架采用最近邻估计器评估12个月的时间依赖性表现。模型性能指标，包括Harrell’s c指数和随时间变化的曲线下面积（AUC），以95%的置信区间进行量化。结果共纳入43例CSCC患者，其中laCSCC 37例（86.1%），mCSCC 6例（14.0%）。中位用药33.1周（8.4个月）后，ORR为72%(31/43)，包括41.9%（13/31）的完全缓解和58.1%（18/31）的部分缓解；病情稳定者占9.7%（3/31）。中位无进展生存期（PFS）为6.4个月（IQR, 3.9-14.7个月）。总体而言，7%的患者因不良事件（3级肾功能不全和肝毒性）而停止治疗。我们发现，从基线到首次就诊的NLR变化（ΔNLR）与PFS之间存在显著的负相关（Coeff = - 0.25; 95% CI [jackknife] = - 0.45-0.05, p = 0.014），显示PFS较短的患者ΔNLR评分较高。根据年龄、全身炎症指数和性别调整后，ΔNLR与36%的进展几率增加相关（HR = 1.36, 95% CI = 0.97-1.89, p = 0.073）。决策曲线分析显示，ΔNLR-based模型在广泛的阈值概率范围内（约7%-49%）具有适度的净收益，但没有确定临床最佳决策阈值。结论本研究提示ΔNLR可作为laCSCC和mCSCC患者的探索性预后指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Dermatologic Therapy 医学-皮肤病学

CiteScore

7.00

自引率

8.30%

发文量

711

审稿时长

3 months

期刊介绍： Dermatologic Therapy has been created to fill an important void in the dermatologic literature: the lack of a readily available source of up-to-date information on the treatment of specific cutaneous diseases and the practical application of specific treatment modalities. Each issue of the journal consists of a series of scholarly review articles written by leaders in dermatology in which they describe, in very specific terms, how they treat particular cutaneous diseases and how they use specific therapeutic agents. The information contained in each issue is so practical and detailed that the reader should be able to directly apply various treatment approaches to daily clinical situations. Because of the specific and practical nature of this publication, Dermatologic Therapy not only serves as a readily available resource for the day-to-day treatment of patients, but also as an evolving therapeutic textbook for the treatment of dermatologic diseases.