Prognostic Value of Neutrophil Percentage–Albumin Ratio in Patients with Advanced Melanoma Treated with Immune Checkpoint Inhibitors

Background: Although immune checkpoint inhibitors (ICIs) have improved survival in advanced melanoma, predicting individual responses remains challenging; thus, practical and inexpensive biomarkers are needed. In this study, we investigated the prognostic value of the neutrophil percentage–albumin ratio (NPAR) in patients with advanced melanoma receiving ICI therapy. Methods: Fifty patients treated in our clinic were included, with a mean age of 53.3 years and 66% being male. Visceral metastases were present in 76% of the cohort. Through conducting Receiver Operating Characteristic (ROC) analysis, we determined an NPAR cut-off value of 1.81, with patients categorized into low (<1.81, n = 27)- and high (≥1.81, n = 23)-NPAR groups. The progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan–Meier and Cox regression analyses. Results: High NPAR (≥1.81) significantly shortened both PFS and OS. In the univariate analysis, high NPAR emerged as a strong risk factor for PFS (HR: 2.68, p = 0.002) and OS (HR: 3.70, p < 0.001), while multivariate analysis confirmed NPAR as an independent negative prognostic factor for PFS (HR: 2.45, p = 0.006) and OS (HR: 2.82, p = 0.003), regardless of clinical variables. Additionally, visceral metastasis was an independent negative predictor of survival. Conclusions: Pre-treatment NPAR levels may be an independent and potential predictor of survival in advanced melanoma patients receiving ICIs. This easily calculable ratio could provide a practical guide for risk stratification.