Evaluated whether baseline neutrophil-to-lymphocyte ratio (NLR) can stratify risk for severe (grade 3–5) checkpoint inhibitor pneumonitis (CIP) occurring within 3 months in NSCLC patients receiving ICIs — using a retrospective discovery cohort (n=102) and a prospective multicenter validation cohort (n=191).
A baseline NLR cut-off of ≥4.75 identified severe CIP risk with AUC 0.81, sensitivity 85.7%, and specificity 64.2%. Severe CIP rates were significantly higher in the high-NLR group in both cohorts (discovery: 15.0% vs. 1.6%, p=0.009; validation: 10.3% vs. 3.3%, p=0.046).
- Severe CIP events were rare (7 and 11 cases in each cohort), limiting statistical power. - Discovery cohort was retrospective and single-center; the prospective validation was multicenter but still relatively small. - NLR cut-off was derived in the discovery cohort and may not generalize across all ICI regimens or tumor subtypes.
Consider checking baseline NLR before starting ICI therapy in NSCLC patients — a value ≥4.75 may flag those at higher risk for severe pneumonitis and warrant closer early monitoring. This is a promising but not yet practice-changing marker; it should complement, not replace, clinical judgment.
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