For 4,484 patients enrolled across five Phase III oncology trials, the answer to an urgent question may have been present in their blood from the start. A study conducted using individual patient data accessed through Vivli, found that the neutrophil-to-lymphocyte ratio (NLR), derived from a standard complete blood count, independently predicted overall survival and progression-free survival across lung, colorectal, and gastric cancers. The findings were published in Frontiers in Oncology in July 2025. 

Dr. Christian Lood, an Associate Professor at the University of Washington specializing in neutrophil biology and biomarker development, has spent his career building the case that neutrophils play a far more consequential role in cancer than the field has historically recognized.

“There is an emerging sense that neutrophils are instrumental in tumor development, he said. I wanted to highlight their unique role in cancer, to further development of novel biomarkers as well as therapeutic targets that are currently not considered in the field.”

Prior studies had proposed NLR as a prognostic marker, but inconsistent findings and limited large-scale validation had kept it from routine clinical use. The scale of data available through Vivli changed what was possible. By accessing records from five Eli Lilly-sponsored Phase III trials spanning three cancer types, Dr. Lood’s team conducted an analysis that earlier work could not support.

“Access to data through Vivli allowed us to analyze a larger patient population and wider variety of treatments than would have been feasible in a standard clinical setting,” he noted.

Baseline NLR proved to be an independent predictor of survival outcomes after adjusting for age, sex, and disease stage. Predictive performance was strongest in patients under 60, non-White patients, those with Stage IV disease, and those with lower functional status at baseline, a pattern that argues against uniform thresholds across populations. Longitudinal NLR change added little beyond the baseline reading. The initial measurement carries the primary prognostic signal. 

Dr. Lood hopes the findings move NLR closer to routine use in oncology and open a research direction focused on soluble markers of neutrophil activation, which may prove more sensitive than cell counts alone in identifying patients with poor prognosis.

“I hope our research will trigger more studies into the potential clinical utility of neutrophil activation biomarkers in cancer patients,” he said.

The individual patient data from the five trials used in this analysis remain available through Vivli.

Further Reading 

Performance of the neutrophil-to-lymphocyte ratio as a prognostic tool for survival in solid cancers — Frontiers in Oncology (July 2025)