免疫检查点抑制剂 (ICI) 治疗引起的癌症治疗相关心血管毒性 (CTR-CVT) 的特征仍不完全，而既往患有心血管疾病的患者是一个特别高风险的群体。缺少对这些患者进行风险分层的有效参数。中性粒细胞与淋巴细胞比率（NLR）已被证明可以预测其他心血管队列中的死亡率和不良事件。本研究旨在检验 NLR 对 ICI 治疗下特别容易发生 CTR-CVT 的患者风险分层的预测能力。我们对 88 名患有既往患有心血管疾病的癌症患者（69±11 岁，25% 女性）进行了分析接受前瞻性埃森心脏肿瘤登记处 (ECoR) 的 ICI 治疗。在患者入组时对 NLR 进行评估，并通过接受者操作特征 (ROC) 曲线分析对低 (< 4.57) 和高 (≥ 4.57) NLR 的患者进行人群划分。根据欧洲心脏肿瘤学指南，终点是 CTR-CVT 的整个范围。中位随访时间为 357 天（四分位距 (IQR)：150-509 天）。我们观察到 4 例心肌炎、17 例血管毒性、3 例动脉高血压、22 例心律失常或 QTc 延长以及 17 例心血管功能障碍。通过单变量 Cox 回归，NLR 与总体 CTR-CVT 相关（风险比 (HR)：1.443；95% 置信区间 (CI) 1.082-1​​.925；p = 0.013）。然而，在调整了进一步的混杂因素后，这种关联性减弱了。在接受 ICI 治疗的既往患有心血管疾病的癌症患者中，NLR 与 CTR-CVT 呈中度相关。 ICI 治疗期间 NLR 的监测可能是这些高危患者风险分层的有效且经济的生物标志物。© 2023。作者。

Cancer therapy-related cardiovascular toxicity (CTR-CVT) from immune checkpoint inhibitor (ICI) therapy is still incompletely characterized, and patients with pre-existing cardiovascular disease represent a particularly high-risk cohort. Valid parameters for risk stratification of these patients are missing. Neutrophil-to-lymphocyte ratio (NLR) has been shown to predict mortality and adverse events in other cardiovascular cohorts. The present study aims to examine the predictive capacity of NLR for risk stratification of patients particularly vulnerable for CTR-CVT under ICI therapy.We performed an analysis of 88 cancer patients (69 ± 11 years, 25% female) with pre-existing cardiovascular disease under ICI therapy from the prospective Essen Cardio-Oncology Registry (ECoR). NLR was assessed at patient enrollment and the population was divided through receiver operator characteristic (ROC) curve analysis in patients with low (< 4.57) and high (≥ 4.57) NLR. Endpoint was the whole spectrum of CTR-CVT, according to the European guidelines on cardio-oncology. The median follow-up was 357 days (interquartile range (IQR): 150-509 days).We observed 4 cases of myocarditis, 17 cases of vascular toxicity, 3 cases of arterial hypertension, 22 cases of arrhythmia or QTc prolongation and 17 cases of cardiovascular dysfunction. NLR was associated with overall CTR-CVT by univariable Cox regression (hazard ratio (HR): 1.443; 95% confidence interval (CI) 1.082-1.925; p = 0.013). However, this association was attenuated after adjusting for further confounders.NLR is moderately associated with CTR-CVT in cancer patients with pre-existing cardiovascular disease under ICI therapy. Surveillance of NLR during ICI therapy might be an effective and economically biomarker for risk stratification in these high-risk patients.© 2023. The Author(s).