Analysis Of Clinical Survival Factors Of Immune Checkpoint Inhibitors In Patients With Advanced Non-small Cell Lung Cancer

Background:Lung cancer is the main cause of cancer-related death in the world.About 85%of the patients are non-small cell lung cancer(NSCLC),more than 65% of them are locally advanced or have metastasized to multiple organs.For a long time,platinum based dual chemotherapy is the first-line standard treatment for advanced NSCLC,but the average overall survival time(OS)is only 8-10 months,and cytotoxic chemotherapy seems to reach the plateau stage in NSCLC treatment.In recent years,the progress of immunotherapy has greatly promoted the treatment of driving gene negative NSCLC,which has a longer survival period and fewer adverse reactions than chemotherapy.Immunotherapy with immunosuppressive checkpoint inhibitors(ICIs)on the programmed cell death 1(PD-1 / L1)axis has long-term survival benefits for patients with advanced NSCLC.Purpose:This study evaluated the therapeutic effect of ICIS in patients with advanced NSCLC,analyzed the factors that may affect the prognosis of such patients,and provided a better therapeutic evaluation for immunotherapy in patients with advanced NSCLC,and at the same time provided a more appropriate treatment plan for patients with potentially poor therapeutic effect of ICIs as early as possible.Methods:Our retrospective analysis recruited 127 patients with advanced and recurrent NSCLC,and all of these patients were treated with ICI in the oncology department of the Second Affiliated Hospital of Nanchang University from September 2017 to January 2020.In the beginning of the treatment of ICI.Using SPSS 26.0 statistical software to process and analyze data.Kaplan Meier method and log rank test were used for progressive free survival(PFS)and single factor analysis,then drawn the survival curve.The best cutoff values of serum albumin,lactate dehydrogenase and neutrophil lymphocyte ratio were determined by ROC curve.Using cox multiple-factors analysis to screen the independent risk factorsof patients’ survival.P < 0.05 represented that the difference was statistically significant.Results:1、Among the 127 patients enrolled in this research.All of the patients,104(104 /127,81.89%)were male and 23(23 / 127,18.11%)were female.The age distribution ranged from 30 to 84 years old,and the median age was 65 years old.Moreover,15 patients had driven mutations,and they had been treated with corresponding targeted drugs and already had drug resistance before the treatment of ICI.2、According to the recist1.1 standard.All of the 127 patients,83 patients had disease progression,69 patients had been died,and 58 patients are still survived.There were 3 cases of complete remission,20 cases of partial remission,21 cases of stable condition,83 cases of disease progression.RR was 18.1% and DCR was 34.6%.Median PFS(mPFS)of all patients is 3.7 months.3、The results of univariate analysis related to PFS showed that: LM(1.4 vs.4.3m,P = 0.01),bone metastases(2.2 vs.4.4m,p=0.046),age≥70 years old(2.5 vs.5.1m,P < 0.001),physical strength score of eastern cooperative oncology group performance status 2-4(1.5 vs.5.8m,P < 0.001),Second line treatment and above(6.5 vs.2.7m,p<0.001),expression of programmed death ligand 1 was negative(1.5vs.5.8m,P < 0.001),driven mutation(1.3 vs.4.8m,P < 0.001),multiple organ metastasis(1.5 vs.6.2m),P < 0.001).The patients with low albumin(2.0 vs.5.6 m,P< 0.001),high lactate dehydrogenase(2.7 vs.5.9 m,P < 0.001),high neutrophil to lymphocyte ratio(6.4 vs.3.1 m,P = 0.002)also had worse PFS.There was no significant relationship between PFS and gender,histological type and smoking status of patients.The difference was not statistically significant.4、Multivariate regression analysis showed that the physical strength score of eastern cooperative oncology group performance status 2-4(HR = 0.23,95% CI:0.14-0.37,P < 0.001),metastasis site ≥ 2(HR = 0.21,95% CI: 0.12-0.35,P < 0.001),neutrophil to lymphocyte ratio ≥ 3.6(HR = 1.52,95% CI: 1.04-2.24,P = 0.032)were related to the shortened PFS,which was an independent clinical predictor of PFS.However,other factors such as liver metastasis,age ≥ 70 years old,driven mutation,albumin and LDH were not independent predictors of PFS.Conclusion:1.The mPFS of patients with advanced NSCLC is 3.7 months.2.ECOG score,multiple organ metastasis and NLR are independent predictors of PFS.