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Background <p>Thyroid cancer represents the most common endocrine malignancy. While targeted therapies have improved clinical outcomes in advanced stages, substantial interpatient heterogeneity in treatment response highlights the critical need for robust predictive biomarkers. The neutrophil-to-lymphocyte ratio (NLR), a hematological parameter reflecting systemic inflammatory status and immune homeostasis, has emerged as a promising prognostic indicator across various solid tumors. In this study, we conducted a comprehensive evaluation of NLR’s predictive capacity for targeted therapeutic efficacy in patients with advanced thyroid cancer.</p> Methods <p>We conducted a retrospective analysis of 328 thyroid cancer patients who received targeted therapy between January 2020 and February 2025. Primary outcome measures included disease control rate, progressive disease, and overall survival. Associations between baseline hematologic parameters and clinical outcomes were evaluated using logistic regression, Kaplan-Meier survival analysis, Cox proportional hazards models, and propensity score matching (PSM) to adjust for potential confounders.</p> Results <p>The cohort (median age 56 years; 42.7% male) comprised 44.8% newly diagnosed and 55.2% recurrent cases. Histopathological analysis identified papillary thyroid carcinoma (PTC, 67.4%) as the most prevalent subtype, followed by anaplastic thyroid carcinoma (ATC, 14.0%), medullary thyroid carcinoma (MTC, 8.8%), follicular thyroid carcinoma (FTC, 6.1%), and poorly differentiated thyroid carcinoma (PDTC, 3.7%). Most patients presented with advanced disease (stage IV: 43.0%). Targeted therapies included Anlotinib (43.3%), Lenvatinib (22.9%), and others. Notably, 23.8% exhibited elevated NLR (≥ 4), associated with poorer outcomes: shorter median OS (15 vs. unreached months; HR = 2.50, <i>p</i> = 0.002) and lower DCR (OR = 6.70, <i>p</i> &lt; 0.001). Multivariate analysis confirmed NLR ≥ 4, ECOG PS ≥ 2+ (HR = 2.73), and age ≥ 55 (HR = 2.90) as independent mortality predictors. These findings persisted after PSM, underscoring NLR’s prognostic value in thyroid cancer.</p> Conclusion <p>Our study demonstrates that an elevated NLR (≥ 4), higher ECOG performance status and advanced age (≥ 55 years) are strong independent predictors of reduced treatment response and poorer survival in thyroid cancer patients receiving targeted therapy. These findings underscore the potential utility of NLR as a readily accessible prognostic biomarker, facilitating personalized therapeutic strategies in clinical practice.</p>

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Predictive and prognostic role of Neutrophil-to-Lymphocyte ratio in patients with advanced thyroid cancer treated with targeted therapy

  • 期刊论文

  • 发表日期：

    2025年10月23日

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  • Tuerhong Diliyaer,
  • Yueyan Ren,
  • Xuejiao Chen,
  • Xixi Zhu,
  • Tuerxun Yilidana,
  • Jiaye Liu,
  • Gang Chen,
  • Zhihui Li

摘要

Background

Thyroid cancer represents the most common endocrine malignancy. While targeted therapies have improved clinical outcomes in advanced stages, substantial interpatient heterogeneity in treatment response highlights the critical need for robust predictive biomarkers. The neutrophil-to-lymphocyte ratio (NLR), a hematological parameter reflecting systemic inflammatory status and immune homeostasis, has emerged as a promising prognostic indicator across various solid tumors. In this study, we conducted a comprehensive evaluation of NLR’s predictive capacity for targeted therapeutic efficacy in patients with advanced thyroid cancer.

Methods

We conducted a retrospective analysis of 328 thyroid cancer patients who received targeted therapy between January 2020 and February 2025. Primary outcome measures included disease control rate, progressive disease, and overall survival. Associations between baseline hematologic parameters and clinical outcomes were evaluated using logistic regression, Kaplan-Meier survival analysis, Cox proportional hazards models, and propensity score matching (PSM) to adjust for potential confounders.

Results

The cohort (median age 56 years; 42.7% male) comprised 44.8% newly diagnosed and 55.2% recurrent cases. Histopathological analysis identified papillary thyroid carcinoma (PTC, 67.4%) as the most prevalent subtype, followed by anaplastic thyroid carcinoma (ATC, 14.0%), medullary thyroid carcinoma (MTC, 8.8%), follicular thyroid carcinoma (FTC, 6.1%), and poorly differentiated thyroid carcinoma (PDTC, 3.7%). Most patients presented with advanced disease (stage IV: 43.0%). Targeted therapies included Anlotinib (43.3%), Lenvatinib (22.9%), and others. Notably, 23.8% exhibited elevated NLR (≥ 4), associated with poorer outcomes: shorter median OS (15 vs. unreached months; HR = 2.50, p = 0.002) and lower DCR (OR = 6.70, p < 0.001). Multivariate analysis confirmed NLR ≥ 4, ECOG PS ≥ 2+ (HR = 2.73), and age ≥ 55 (HR = 2.90) as independent mortality predictors. These findings persisted after PSM, underscoring NLR’s prognostic value in thyroid cancer.

Conclusion

Our study demonstrates that an elevated NLR (≥ 4), higher ECOG performance status and advanced age (≥ 55 years) are strong independent predictors of reduced treatment response and poorer survival in thyroid cancer patients receiving targeted therapy. These findings underscore the potential utility of NLR as a readily accessible prognostic biomarker, facilitating personalized therapeutic strategies in clinical practice.