{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:03:28Z","timestamp":1791644608123,"version":"4.3.4"},"reference-count":53,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Neutrophil\u2010to\u2010lymphocyte ratio (NLR) can be treated as a simple indicator of patients' immune status by representing the state of the systemic inflammatory response. Immunotherapy now is the accepted second\u2010line treatment for recurrent or metastatic nasopharyngeal carcinoma (R\/M NPC). However, the significance of NLR in patients with R\/M NPC undergoing treatment with PD\u2010L1 (programmed cell death\u2010ligand 1) inhibitors is still uncertain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed the relationship between baseline NLR with 153 patients' efficacy and survival from a multicenter, prospective, Phase 2 study. We employed restricted cubic spline plots to get the nonlinear relationship between NLR and progression\u2010free survival (PFS) or overall survival (OS). We identified the ideal cut\u2010off value through the analysis of the receiver operating characteristic curve (ROC curve). We used Logistic regression, Cox regression, Log\u2010rank test, and Kaplan\u2013Meier method to analyze the association between NLR and patients' disease control rate (DCR) and PFS or OS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The ideal threshold value for NLR was 2.826. NLR was identified as a significant independent predictor of DCR (OR\u2009=\u20090.17, 95% CI\u2009=\u20090.05\u20130.48, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), indicating that a higher NLR is associated with worse DCR. NLR (AUC\u2009=\u20090.634) showed superior predictive capability for DCR in comparison to lymphocytes (AUC\u2009=\u20090.602) and neutrophils (AUC\u2009=\u20090.593). High NLR values were risk factors both for poor PFS (HR\u2009=\u20092.53, 95% CI\u2009=\u20091.58\u20134.06, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and OS (HR\u2009=\u20093.89, 95% CI\u2009=\u20092.09\u20137.24, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Elevated NLR is strongly associated with lower response to treatment and reduced survival rates in patients with R\/M NPC being treated with PD\u2010L1 inhibitors. Patients with high NLR values have poor efficacy and survival.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hed.28101","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T02:15:47Z","timestamp":1739412947000},"page":"1928-1938","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Neutrophil\u2010to\u2010Lymphocyte Ratio as a Predictor for <scp>PD<\/scp>\u2010<scp>L1<\/scp> Inhibitor Treatment in Recurrent or Metastatic Nasopharyngeal Carcinoma"],"prefix":"10.1002","volume":"47","author":[{"given":"Kun","family":"Gao","sequence":"first","affiliation":[{"name":"Division of Head &amp; Neck Tumor Multimodality Treatment, Department of Radiation Oncology, Cancer Center, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhigong","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Targeting Therapy &amp; Immunology, Cancer Center, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4848-4951","authenticated-orcid":false,"given":"Zheran","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Targeting Therapy &amp; Immunology, Cancer Center, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyan","family":"Pei","sequence":"additional","affiliation":[{"name":"Department of Targeting Therapy &amp; Immunology, Cancer Center, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huilin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Targeting Therapy &amp; Immunology, Cancer Center, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ge","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Targeting Therapy &amp; Immunology, Cancer Center, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Xiang","sequence":"additional","affiliation":[{"name":"West China Lecheng Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyou","family":"Ge","sequence":"additional","affiliation":[{"name":"Sichuan Kelun\u2010Biotech Biopharmaceutical Co. Ltd  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Qing","sequence":"additional","affiliation":[{"name":"Sichuan Kelun\u2010Biotech Biopharmaceutical Co. Ltd  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youneng","family":"Wei","sequence":"additional","affiliation":[{"name":"Sichuan Kelun\u2010Biotech Biopharmaceutical Co. Ltd  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0169-0926","authenticated-orcid":false,"given":"Ping","family":"Ai","sequence":"additional","affiliation":[{"name":"Division of Head &amp; Neck Tumor Multimodality Treatment, Department of Radiation Oncology, Cancer Center, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Abdominal Tumor Multimodality Treatment, Department of Radiation Oncology, Cancer Center, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingchen","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Targeting Therapy &amp; Immunology, Cancer Center, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30956-0"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2021.106455"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","unstructured":"A. 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