Predictive Factors For Durable Clinical Benefit Of PD-1 Inhibitors In Patients With Advanced Non-small Cell Lung Cancer

Background/Aims:The study aimed to investigate the clinical independent prognostic factors associated with durable clinical benefit in NSCLC patients treated with PD-1inhibitors and construct a nomogram model based on these independent prognostic factors.Methods:This study retrospectively screened 248 patients who were diagnosed as NSCLC and treated with PD-1 inhibitors at the Department of Oncology of the Second Affiliated Hospital of Nanchang University from October 2018 to December 2020.Durable clinical benefit(DCB)was defined as no disease progression for at least 6months after receiving PD-1 inhibitors.Non-durable benefit(NDB)was defined as confirmed disease progression or death within 6 months.Univariate and multivariate logistic regression were used to analyze the independent prognostic factors affecting the durable benefit of PD-1 inhibitors treatment.A nomogram model for predicting durable benefit of PD-1 inhibitors was established based on the above three independent prognostic factors.The nomogram was evaluated using the C-index,calibration curve,and receiver operating characteristic(ROC)analysis.Results:A total of 90 eligible patients with stage IIIC or IV NSCLC were included in the study.49(54.4%)were in the DCB group and 41(45.6%)in the NDB group.Multivariate logistic regression analysis indicated that ECOG PS of 0-1(OR: 4.529,95% CI: 1.332-15.396,P < 0.016),metastatic site < 3(OR: 3.306,95% CI: 1.012-10.797,P < 0.048),and neutrophil to lymphocyte ratio(NLR)≤ 4(OR: 3.017,95%CI: 1.108-8.210,P < 0.031)were independent prognostic factors for DCB with PD-1inhibitors treatment.A nomogram model was constructed to predict the sustained benefit of PD-1 inhibitors based on the above three independent prognostic factors.The C-index of the nomogram model was 0.819(95% CI: 0.732-0.906),the calibration curve showed that the prediction model had good agreement with the measured values,and the area under curve(AUC)of the ROC curve was 0.819(95%CI: 0.732-0.906),indicating that the nomogram model had good predictive ability.Conclusion:Our study showed that NSCLC patients with an ECOG PS of 0-1,number of metastatic sites < 3,or baseline NLR ≤ 4 were more likely to have sustained benefit with PD-1 inhibitors therapy.The nomogram model based on the three independent prognostic factors,can better predict the probability of durable benefit from PD-1inhibitor therapy in NSCLC patients.