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Meta-Analysis
. 2025 Jul 21:16:1633034.
doi: 10.3389/fimmu.2025.1633034. eCollection 2025.

The predictive value of the neutrophil/eosinophil ratio in cancer patients undergoing immune checkpoint inhibition: a meta-analysis and a validation cohort in hepatocellular carcinoma

Yang Xu #  1 , Yang Liu #  1 , Huimin Han  1 , Zhen He  1 , Wei Cao  1
Affiliations
Meta-Analysis

The predictive value of the neutrophil/eosinophil ratio in cancer patients undergoing immune checkpoint inhibition: a meta-analysis and a validation cohort in hepatocellular carcinoma

Yang Xu et al. Front Immunol. .

Abstract

Objective: This study was conducted to determine the prognostic relevance of neutrophil/eosinophil ratio (NER) in cancer patients receiving immune checkpoint inhibition therapy.

Methods: A comprehensive search of the literature was carried out across PubMed, EMBASE, and the Cochrane Library to identify relevant studies published before May 2025. Key clinical endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Additionally, a retrospective cohort analysis involving 67 hepatocellular carcinoma (HCC) patients who received ICIs at our center was undertaken to evaluate the prognostic significance of NER with respect to OS and PFS.

Results: This meta-analysis incorporated 12 studies comprising a total of 1,716 patients. Higher baseline NER was consistently associated with poorer clinical outcomes, including shorter OS (HR = 1.82, 95% CI: 1.57-2.11, p < 0.001) and PFS (HR = 1.62, 95% CI: 1.34-2.97, p < 0.001), as well as lower ORR (HR = 0.50, 95% CI: 0.37-0.68, p < 0.001) and DCR (OR = 0.44, 95% CI: 0.31-0.61, p < 0.001). Complementing these findings, analysis of a retrospective cohort from our institution involving HCC patients revealed that individuals with higher NER experienced significantly worse OS (p = 0.006) and PFS (p = 0.033) when compared to those with lower NER levels.

Conclusion: These findings underscore the prognostic significance of pretreatment NER in cancer patients receiving ICI therapy. Integrating NER into standard clinical evaluation may enhance risk stratification and contribute to the personalization of treatment strategies.

Keywords: cancer; hepatocellular carcinoma; immune checkpoint inhibitors; neutrophil-to-eosinophil ratio; prognosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow diagram of identifying eligible studies.
Figure 2
Figure 2
Forest plots depicting the association between the baseline neutrophil/eosinophil ratio and overall survival in cancer patients treated with ICIs (A). Sensitivity analysis of the association between baseline neutrophil/eosinophil ratio and overall survival in cancer patients treated with ICIs (B). HR, hazard ratio; CI, confidence interval.
Figure 3
Figure 3
Subgroup analysis based on the Cox model revealed the relationship between the baseline neutrophil/eosinophil ratio and the overall survival of cancer patients treated with immune checkpoint inhibitors. HR, hazard ratio; CI, confidence interval.
Figure 4
Figure 4
Forest plots depicting the association between the baseline neutrophil/eosinophil ratio and progression-free survival in cancer patients treated with ICIs (A). Sensitivity analysis of the association between baseline neutrophil/eosinophil ratio and progression-free survival in cancer patients treated with ICIs (B). HR, hazard ratio; CI, confidence interval. OR, odds ratio; CI, confidence interval.
Figure 5
Figure 5
Subgroup analysis based on the Cox model revealed the relationship between the baseline neutrophil/eosinophil ratio and the progression-free survival of cancer patients treated with immune checkpoint inhibitors. HR, hazard ratio; CI, confidence interval. OR, odds ratio; CI, confidence interval.
Figure 6
Figure 6
Forest plots depicting the association between the baseline neutrophil/eosinophil ratio and objective response rate in cancer patients treated with ICIs (A). Sensitivity analysis of the association between baseline neutrophil/eosinophil ratio and objective response rate in cancer patients treated with ICIs (B). OR, odds ratio; CI, confidence interval.
Figure 7
Figure 7
Forest plots depicting the association between the baseline neutrophil/eosinophil ratio and disease control rate in cancer patients treated with ICIs (A). Sensitivity analysis of the association between baseline neutrophil/eosinophil ratio and disease control rate in cancer patients treated with ICIs (B). OR, odds ratio; CI, confidence interval.
Figure 8
Figure 8
Kaplan–Meier survival estimates for overall survival and progression-free survival are presented, stratified by baseline neutrophil-to-eosinophil ratio levels in our cohorts. HR, hazard ratio; CI, confidence interval.
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