{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:25:40Z","timestamp":1788956740178,"version":"build-2803163510"},"reference-count":41,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>Severe checkpoint inhibitor pneumonitis (CIP), particularly when it develops within 6\u201312\u2009weeks, is a potentially fatal adverse event in patients with non\u2010small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs). Although neutrophil\u2010to\u2010lymphocyte ratio (NLR) has been reported to predict immune\u2010related adverse events, its role in severe CIP remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The discovery cohort retrospectively enrolled 102 patients with NSCLC treated with ICI monotherapy at Hiroshima University Hospital. The validation cohort prospectively enrolled 191 NSCLC patients receiving first\u2010line treatment, including ICI, at 15 institutions. Severe CIP was defined as grade 3\u20135 pneumonitis occurring within 3\u2009months of treatment initiation. The cut\u2010off level of the baseline NLR was identified by receiver operating characteristic curve analysis in the discovery cohort, and the predictive accuracy was analyzed and confirmed in both cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Severe CIP was observed in seven (6.9%) and 11 (5.8%) patients in the discovery and validation cohorts, respectively. In the discovery cohort, the baseline NLR was higher in patients with severe CIP than in those without (17.29 [4.76\u201320.73] vs. 3.70 [2.64\u20136.68],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006), and the cut\u2010off level of the baseline NLR was set at 4.75 (AUC 0.81; sensitivity 85.7%, specificity 64.2%). The incidence of severe CIP was significantly higher in patients with higher baseline NLR levels (\u2265\u20094.75) than in those without, in both cohorts (discovery: 15.0% vs. 1.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009; validation: 10.3% vs. 3.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Baseline NLR is a promising risk stratification marker for severe CIP.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/resp70267-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/resp.70267","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T12:45:08Z","timestamp":1780577108000},"page":"922-932","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Baseline Neutrophil\u2010To\u2010Lymphocyte Ratio as a Risk Stratification Marker for Severe Checkpoint Inhibitor Pneumonitis in Patients With Non\u2010Small Cell Lung Cancer: A Two\u2010Cohort Study With Retrospective Discovery\u00a0and\u00a0Prospective Validation"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9091-3397","authenticated-orcid":false,"given":"Tetsu","family":"Hirakawa","sequence":"first","affiliation":[{"name":"Department of Molecular and Internal Medicine Graduate School of Biomedical and Health Sciences, Hiroshima University  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9117-1934","authenticated-orcid":false,"given":"Kakuhiro","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun","family":"Takao","sequence":"additional","affiliation":[{"name":"Department of Respiratory Internal Medicine Hiroshima City Hiroshima Citizens Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Kanaji","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Hematology, Rheumatology, and Respiratory Medicine Faculty of Medicine, Kagawa University  Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoko","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Hiroshima Red Cross Hospital &amp; Atomic\u2010Bomb Survivors Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kozue","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine National Hospital Organization Higashihiroshima Medical Center  Higashihiroshima 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