Neutrophil‐to‐lymphocyte ratio associates with nutritional parameters, intratumoral immune profiles, and clinical outcomes of pembrolizumab in head and neck squamous cell carcinoma

Abstract Background The relationship between the tumor‐immune microenvironment and systemic inflammatory markers, including neutrophil‐to‐lymphocyte ratio (NLR), is unclear. Methods We examined the characteristics of systemic inflammatory markers and tumor immune microenvironments in relation to treatment outcomes in 29 consecutive patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) who received pembrolizumab, using 14‐marker multiplex immunohistochemistry and image cytometry. Results NLR ≥4.5 (high NLR) at pretreatment status significantly correlated with short overall survival (OS) and progression‐free survival‐2 (PFS2) and malnutrition status. High NLR in peripheral blood was significantly correlated with low lymphoid cell and high tumor‐associated macrophage counts in tissues, especially myeloid‐to‐lymphoid cell ratios, suggesting an association between circulating and intratumoral immune complexity profiles. Conclusions This study suggests a link between NLR in circulating blood, systemic nutritional status, and immune composition within the tumor.