| Objective:To analyze the relationship between pulmonary immune prognostic index(LIPI)score and clinicopathological features and prognosis of metastatic non-small cell lung cancer(m NSCLC),and to explore whether LIPI score is related to its clinicopathological features,therapeutic efficacy and prognosis,so as to provide a simple and feasible laboratory index for predicting the curative effect and evaluating the prognosis of this kind of patients.Methods:Patients who were diagnosed with metastatic non-small cell lung cancer in the Second Hospital of Jilin University from January 1,2015 to November 31,2020 were screened,and their clinicopathological data were collected.The patients with metastatic non-small cell lung cancer were divided into three groups according to Lung immune prognostic index score:(1)Good group: the ratio of derived neutrophils to lymphocytes,that is,the number of neutrophils /[leukocytes-neutrophils](derived Neutrophil to Lymphocyte Ratio,d NLR)≤ 3 and Lactate Dehydrogenase(LDH)≤ the upper limit of normal value(ULN);(2)Intermediate group: d NLR>3 or LDH>ULN;(3)Poor group: d NLR>3 and LDH>ULN.Clinicopathological data to be collected include: age,sex,smoking history,blood routine,LDH,tumor markers,histopathological types,immunohistochemistry,Ki-67 level,PD-L1 expression level,treatment plan,etc.The patients were followed up to analyze their survival and prognosis.The SPSS 26.0 statistical software was used for statistical processing,the utilization rate of counting data was expressed,and chi-square test was used to compare counting data.when the theoretical frequency was less than 5,Fisher exact probability method was used,and the test level was 0.05.Cox proportional hazard regression model was used to analyze the influencing factors,and the single-factor meaningful variables were put into the multivariate regression analysis model to calculate the risk value of each covariable(hazardratio,HR)and the 95% confidence interval of HR.Kaplan-Meier survival analysis curve was drawn and log-rank test was used to compare and analyze the survival curve.Results:1.Among the 232 patients with metastatic non-small cell lung cancer,the median age was 63 years old(25-84 years old).Among them,91 cases were in the good group(91/232,39.2%),the median age was 65 years old(25-84 years old),76 cases were in the intermediate group(76/232,32.8%s),the median age was 62 years old(36-83 years old),65 cases were in the poor group(65/232,28.0%),the median age was 62 years old(37-77 years old).Male,non-smoker,PS score<2,adenocarcinoma,single organ metastasis,high expression of known Ki-67(≥ 25%),high expression of known PD-L1(≥50%),EGFR mutations in known gene mutations,CEA >5ng/ml,Cyfra21-1>2.08ng/ml,CA125>35U/ml,LDH ≤ ULN,d NLR ≤ 3,chemotherapy accounted for more in first-line therapy,they account for 54.3%、62.9%、88.8%、73.3%、61.2%、32.8%、7.3%、32.3%、61.2%、72.4%、60.3%、51.7%、59.5%、50.4% of the total.There are fewer patients with brain metastasis,bone metastasis,liver metastasis,other organ metastasis(except brain,bone and liver metastasis),malignant pleural effusion,ALK mutations in known gene mutations and combined therapy,they account for 12.5%、46.1%、10.3%、40.9%、26.7%、4.3%、32.3% of the total.2.There were significant differences in age,smoking history,PD-L1 expression,Cyfra21-1 and combination therapy among the three LIPI groups.There was no significant difference in gender,ECOG PS score,pathological type,number of metastatic organs,brain metastasis,bone metastasis,liver metastasis,other organ metastasis(except with brain,bone and liver metastasis),malignant pleural effusion,Ki-67,EGFR mutation,ALK fusion gene,CEA,CA125 and first-line treatment.Compared with the good group and the intermediate group,the poor group had the characteristics of more smokers,less positive expression of PD-L1,higher level of Cyfra21-1 than 2.08ng/ml and higher proportion of patients without combined therapy.3.The DCR of LIPI score good group,the intermediate group and the poor group was 44.0%,25.0% and 16.9% respectively,and the three groups had statistical significance in DCR;the ORR was 16.5%,9.2% and 9.2% respectively,and there was no statistical significance in ORR.4.The median PFS of LIPI score good group,intermediate group and poor group was 18.0,12.0,5.0 months respectively,there was significant difference among the three groups.Cox univariate analysis showed that poor LIPI score,malignant pleural effusion,LDH > ULN and no combined treatment were associated with shorter PFS in patients with m NSCLC.Multivariate analysis showed that the poor LIPI score group compared with the intermediate group,malignant pleural effusion and no combined treatment were independent adverse prognostic factors for PFS in patients with m NSCLC.5.Cox univariate analysis showed that poor LIPI score,PS score ≥ 2,the pathological type was squamous cell carcinoma compared with adenocarcinoma,malignant pleural effusion,LDH > ULN,d NLR > 3 and no combined therapy were associated with shorter OS in patients with m NSCLC.Multivariate analysis showed that poor LIPI score,PS score≥2,the pathological type was squamous cell carcinoma compared with adenocarcinoma,malignant pleural effusion and no combined treatment were independent adverse prognostic factors for OS in patients with m NSCLC.Conclusions:1.There were significant differences in age,smoking history,PD-L1 expression,Cyfra21-1 level and combined therapy among the three groups in LIPI score.Compared with the good group and the intermediate group,the poor group had the characteristics of more smokers,less positive expression of PD-L1,higher level of Cyfra21-1 than 2.08ng/ml and higher proportion of patients without combined therapy.2.The LIPI score did not significantly affect the ORR of patients with m NSCLC,but the DCR decreased and the PFS shortened in patients with poor LIPI score.3.Poor LIPI score,PS score ≥ 2,the pathological type was squamous cell carcinoma compared with adenocarcinoma,malignant pleural effusion and no combined treatment were independent adverse prognostic factors of OS in patients with mNSCLC. |
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