The Prognostic Value Of Peripheral Blood Inflammatory Markers In Patients With Advanced Non-small Cell Lung Cancer Treated With Anti-PD-1 Immunotherapy

Objective:The purpose of this study was to investigate the value of lymphocyte / monocyte ratio（LMR）,system inflammation index（SII）and prognostic nutrition index（PNI）in the treatment and prognosis of advanced non-small cell lung cancer（NSCLC）patients treated with anti-PD-1 immunotherapy.Methods:A total of 124 patients with advanced NSCLC who received immunotherapy in our hospital from January 2019 to June 2021 were screened.And collected the general clinical data of the patients,including age,sex,smoking status,pathology type,tumor stage,number of treatment lines,metastasis,gene mutation status,ECOG score etc,and made a retrospective analysis.The peripheral hematological indexes including peripheral blood neutrophil count（N）,lymphocyte count（L）,monocyte count（M）,platelet count（P）and serum albumin（serum albumin,Alb）were included on the data of the first diagnosis or one week prior to the start of immunosuppressive therapy,and the values of LMR,SII and PNI were calculated.The receiver operating characteristic curve（ROC）was drawn and the area under the curve（AUC）was calculated to determine the best truncation value of the three inflammatory markers.According to the best truncation value,the above three inflammatory markers were divided into high value group and low value group.Evaluation of short-term efficacy:the therapeutic efficacy was graded according to the Solid Tumor Response Evaluation Criteria（RECIST）version 1.1.The objective response rate（ORR）and disease control rate（DCR）among groups were calculated.χ~2 test was used to compare the differences between high value group and low value group.Evaluation of long-term efficacy: univariate survival analysis was performed by Kaplan-Meier method,survival difference between high value group and low value group was analyzed by Log-rank test,Cox proportional hazard regression model was used for multivariate analysis.All data were analyzed by SPSS25.0 software（SPSS,Inc.,Chicago,IL,USA）.P<0.05,the difference was statistically significant.Results:1.Based on the receiver operating characteristic curve（ROC）and the area under the curve（AUC）,the best truncation values for LMR,SII,and PNI were calculated.It was determined that the best truncation value of LMR was 1.69（sensitivity:0.983,specificity:0.354,AUC value:0.661）,and that of SII was 1146.61（sensitivity:0.615,specificity:0.847,AUC value:0.757）,and that of PNI was 42.37（sensitivity:0.898,specificity:0.446,AUC value:0.682）.LMR was divided into H-LMR（LMR≥1.69） group（n=100）and L-LMR（LMR<1.69）group（n=24）.SII was divided into H-SII（SII≥1146.61）group（n=49）and L-SII（SII<1146.61）group（n=75）.PNI was divided into H-PNI（PNI≥42.37）group（n=89）and L-PNI（PNI<42.37）group（n=35）.2.χ~2 test showed that the ORR of H-LMR group and L-LMR group were 30.0% and 20.8% respectively（P=0.370）,DCR of the two groups were 63.0% and 54.2% respectively（P=0.425）.The ORR of H-SII group and L-SII group were 26.5%,29.3% respectively（P=0.735）,DCR of the two groups were 49.0% and 69.3% respectively（P=0.023）.The ORR of H-PNI group and L-PNI group were 30.3% and 22.9% respectively（P=0.405）,DCR of the two groups were 65.2% and 51.4% respectively（P=0.157）.3.The results of univariate analysis showed that LMR,SII,PNI were correlated with progression free survival（PFS）and overall survival（OS）（P<0.05）.The results of multivariate analysis showed that SII（HR=9.334,P<0.001）and PNI（HR=0.336,P=0.001）were independent factors to evaluate the prognostic value of immunosuppressant therapy in patients with advanced NSCLC,and the prognostic value of SII was better than that of PNI.Further multivariate model analysis showed that the patients in group A（two favorable factors）had both better PFS and OS than that in group B（with one favorable factor）or group C（no favorable factors）（P<0.001）.Conclusion:For the advanced NSCLC patients who choose immunotherapy,the inflammatory markers SII and PNI before treatment can initially evaluate the therapeutic efficacy and long-term efficacy of the patients,and can guide the choice of clinical treatment and may help screen the patients who are suitable for immunotherapy.