Correlation Between NLR And CD4+T Lymphocyte Levels In Peripheral Blood And Immunotherapy Efficacy And Prognosis In Advanced Liver Metastatic NSCLC

Background and objectives:In China,the incidence and mortality of lung cancer among malignant tumors are still high,and advanced patients occupy the majority of the diagnosis.Non-small cell lung cancer(NSCLC)is one of the common histopathological subtypes of lung cancer,accounting for the vast majority of lung cancer cases.Brain,bone and liver are the common metastatic sites of advanced lung cancer,accounting for 22%,15%and 9%,respectively.However,the current big data clinical case analysis shows that: In advanced NSCLC,compared with brain,bone and adrenal metastasis,patients with liver metastasis had the worst prognosis,and overall survival(OS)was only 3-6months.Immunotherapy represented by immunoassay site inhibitors is a milestone in the treatment of advanced lung cancer.It includes Programmed Death protein 1(PD-1)antibody,Programmed Death ligand 1(PD-L1)antibody and Cytotoxic T lymphocyte-associated protein 4(Cytotoxic)The advent of immunoassay site inhibitors including T-lymphocyte associated protein 4(CTLA-4)mab has changed the pattern of treatment for advanced lung cancer and prolonged the survival of patients.Immunoassay site inhibitors combined with chemotherapy are currently the standard treatment for drive gene-negative advanced NSCLC.However,we have found a clinical phenomenon that in patients diagnosed with advanced NSCLC and treated with immunoassay site inhibitors,compared with other sites such as brain and bone metastases,The efficacy of immunoassay site inhibitors in patients with liver metastasis often fails to reach the ideal level,and most patients rapidly develop tumor-related death events.However,we are faced with the problem is that there is no useful biomarkers to predict patients with advanced non-small cell lung cancer with liver metastasis to accept the curative effect and prognosis of immune examination site inhibitor combination chemotherapy,looking for simple and effective biomarkers in the guide to establish individualized treatment plan and prognosis evaluation is of great significance.Inflammation,immune cells and tumor,produce the progress closely coherent process,such as,transfer and neutrophils and lymphocytes in peripheral blood represents the level of systemic inflammation,the T lymphocyte subtypes and closely related to cellular immunity,therefore,this study based on 56 cases drive gene negative patients with advanced non-small-cell lung cancer with liver metastasis of retrospective study,To investigate the efficacy and prognosis of immunoassay site inhibitors in patients with liver metastasis and the relationship between Neutrophil to lymphocyte ratio(NLR)and CD4+T lymphocyte level in peripheral blood before treatment.To provide simple and effective clinical evidence for the therapeutic efficacy and prognosis monitoring of patients with advanced non-small cell lung cancer complicated with liver metastasis.Methods:In this study,we collected the clinical data of patients with advanced NSCLC complicated with liver metastasis diagnosed by clinical pathology in the Department of Respiratory and Critical care and medical Oncology of Ganzhou People’s Hospital from January 2019 to July 2021 and treated with immunoassay site inhibitors.These data included neutrophil count,lymphocyte count,CD4+T lymphocyte count,Lactate dehydrogenase(LDH),Carcino-embryonic antigen,CEA level and second-line treatment,age,TNM stage,gender,PS score,smoking history,pathological type,degree of differentiation,etc.Results of efficacy evaluation,Immune-related adverse events IRAE and survival were recorded.Results:NLR and CD4+T lymphocyte counts before treatment were significantly correlated with the Objective Response Rate(ORR)and the incidence of immune-related adverse events.Kaplan-meier method was used for univariate analysis of progression-free survival(PFS)and Overall survival(OS)of patients,and we concluded that the risk factors affecting PFS in patients with liver metastasis were as follows: Low differentiation,high NLR,low CD4+T lymphocytes,high LDH;The risk factors for OS in patients with liver metastasis were low differentiation,low CD4+T lymphocytes and high NLR.COX proportional risk model was used to analyze the risk factors obtained by univariate analysis.The independent risk factors of PFS in patients with liver metastasis were: high NLR,low CD4+T lymphocytes;The independent risk factors for OS in patients with liver metastasis were high NLR and low differentiation.Conclusion:1.Before treatment,high NLR and low CD4+T lymphocytes were associated with poor prognosis in advanced NSCLC patients with liver metastasis;2.high NLR,low CD4+T lymphocyte count and differentiation degree before treatment are independent risk factors affecting the prognosis of patients with advanced NSCLC complicated with liver metastasis.3.Pre-treatment low NLR and high CD4+T lymphocytes were associated with higher incidence of IRAE events in patients with advanced NSCLC with liver metastases and better ORR receiving immunotherapy.