| Objective:To investigate the value of peripheral serological indicators such as the platelet to lymphocyte ratio(PLR)and the neutrophil-lymphocyte ratio(NLR)in predicting the prognosis of patients with stage IIIB-IV non-small cell lung cancer(NSCLC)treated with programmed death protein-1(PD-1)monoclonal antibody.Methods:A retrospective collection of 135 patients with stage IIIB-IV NSCLC treated with PD-1monoclonal antibody immunotherapy in the Department of Respiratory Medicine and Oncology of the First Affiliated Hospital of Gannan Medical College from January 2019 to February 2021.Clinical case data of the patients and their blood count one week before treatment with anti-PD-1 monoclonal antibody were collected and PLR as well as NLR values were calculated according to the formula.First,the diagnostic value of PLR,NLR and PLR combined with NLR was compared using the area under the curve(AUC)of the plotted receiver operating characteristic curve(ROC).Differences in objective remission rate(ORR)and disease control rate(DCR)were examined separately according to the chi-square test.Univariate and multivariate analyses using logistic regression models to identify independent influences on immune-related adverse events(ir AEs).Survival analysis was performed using the Kaplan-Meier method and survival curves were plotted.Multi-factor COX regression analysis of factors with statistically significant or differential trends in single factors.Finally,the prognosis-related Nomogram is plotted,and the predictive accuracy of the model is assessed.The above statistics were performed using Graph Pad Prism 8.0.1 and R Studio.Differences were considered statistically significant at P < 0.05.Results:Firstly,ROC curves were plotted and the AUC values for the PLR,NLR and PLR combined with NLR groups were: 0.68,0.77 and 0.71 respectively.Using the median PLR and NLR,the 153 patients who met the criteria were divided into a high PLR group(H-PLR >200.00,67)and a low PLR group(L-PLR ≤ 200.00,66),and a high NLR group(H-NLR >3.56,65)and a low NLR group(L-NLR ≤ 3.56,68).During the observation period,22patients(16.5%)experienced Immune-related adverse events(ir AE),of which 18 patients experienced grade 2-3 adverse events,5 patients discontinued due to 4 adverse reactions.The chi-square test showed that in the H-PLR and L-PLR groups the DCR was 68.66% and 66.67%(P=0.76)and the ORR was 23.88% and 21.21%(P=0.61)respectively;in the H-NLR and LNLR groups the DCR was 67.69% and 67.65%(P=1.00)respectively and the ORR was 18.46%and 26.47%(P=0.17).Univariate analysis showed that the number of metastatic sites,driver gene mutation status,PLR and NLR were associated with both progression-free survival(PFS)and overall survival(OS)of patients(P<0.05).Multifactorial analysis showed that NLR could be used as a predictor of PFS(Hazard ratio [HR],0.201,95% CI,0.060-0.670;p=0.009)and OS(HR,0.413,95% CI,0.226-0.754;p< 0.005)were associated as independent factors.Finally,a Nomogram model was constructed to predict survival in patients at 6,12 and 18 months,and calibration curves were performed,with the results suggesting that 12 months may be a better predictive time for patients,with a calculated Cindex value of 0.70(95% CI,0.602-0.790).Conclusion:NLR could be used as a predictor of good survival biology in patients with stage IIIBIV NSCLC treated with PD-1 inhibitors.The use of such new and cost-effective serological markers in combination with currently available immunomarkers(PD-L1,TMB,MSI)in the clinical setting was also a future direction of interest. |
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