Similarly, in a recent publication of 224 patients with stage IV melanoma treated with anti-PD-1 immunotherapy (nivolumab or pembrolizumab) as the initial treatment, the baseline NLR was closely related to ECOG PS and the number of metastatic sites, and elevated NLR was associated with lower ECOG PS and more metastatic sites (40). This evidence concerns the gene PDCD1 and melanoma.