Correlation Analysis Of NLR And PD-L1 Expression With Adverse Reactions And Prognosis Of PD-1 Inhibitor Therapy In Patients With NSCLC

Objective:This study was the correlation of NLR,PLR,LMR and PD-L1 expression before immune checkpoint inhibitors with therapeutic effect and immune-related adverse events in primary lung cancer patients before immunotherapy,and to evaluate predictive biomarkers for non-small cell lung cancer,so as to provide some guidance for clinical diagnosis and treatment.Methods:The general clinical data and prognosis of non-small cell lung cancer patients treated with immune checkpoint inhibitors in the Second Affiliated Hospital of Hainan Medical College Hospital from January 2019 to April 2021 were collected,to build a data database of non-small cell lung cancer immune checkpoint inhibitors,χ2 test,Logistic regression analysis and Kaplan-Meier survival analysis were used to analyze the correlation between clinical indicators and prognosis and immune adverse reactions.Results:1.A total of 101 non-small cell lung cancer patients with complete clinical data were included.Of these,77 were male and 24 were female,with a mean age(63.06 ± 9.83)years,53 patients with previous smoking history,with an average BMI of 21.09±2.97,40 patients with squamous cell carcinoma,61 patients with adenocarcinoma,and 86 patients with PS score<2.There were 15 patients with PS score=2,13 patients with distant metastasis≥ 3 sites,88 patients with metastasis<3 sites.Two weeks before and after treatment,25 patients received antibiotics and 39 patients received hormone therapy.Before treatment,the average hemoglobin was(120.03±17.58)g/L,NLR was 4.11±3.31,PLR was 208.52±104.78,LMR was 3.05±2.02,and ALB was(38.99±4.37)g/L.PD-L1 expression was positive in 62 cases and negative in 39 cases.2.χ2 test showed that there was significant difference between Hb and PD-L1 expression and immunotherapy adverse reactions(P<0.05).There were no significant differences in gender,age,smoking,BMI group,PS,pathological type,stage,NLR,PLR,LMR,ALB,antibiotic use,hormone use,metastatic site and irAEs(P>0.05).3.Positive PD-L1 expression was a risk factor for the occurrence of irAEs(OR=8.696),and Hb≥ 120 was a protective factor for the occurrence of irAEs(OR=0.363).4.35 patients with immune-related adverse reactions,including 12 patients with immune-related dermatitis,11patients with hypothyroidism,9 patients with pneumonia,3 patients with hepatitis,and 10 patients with CTCAE grade 1.21 for level 2 and 4 for Level 3.5.The median PFS time was 8.50(4.42,12.58)months,and the median OS time was 16.50(10.40,22.60)months.Univariate analysis showed that there were statistically significant differences in ECOG,tumor stage,antibiotic use,PD-L1 expression and cumulative PFS(P<0.05),and there were statistically significant differences in ECOG,NLR and PD-L1 expression and cumulative OS(P<0.05).Multivariate analysis showed that the expression of PS and PD-L1 was statistically significant in PFS regression analysis(P<0.05).6.The risk of progression or death in patients with PS=2 was 2.938 times that in patients with<2,and the risk of progression or death in patients with PD-L1 positive expression was 0.485 times that in patients with PD-L1 positive expression.The expression of PS,NLR and PD-L1 was statistically significant in OS regression analysis(P<0.05),and the risk of death in patients with PS=2 was 4.343 times that in patients with<2.The risk of death was 2.635 times higher in patients with NLR>3.17 than in patients with NLR≤3.17.Patients with positive PD-L1 expression had a 0.484 times higher risk of death than those with negative PD-L1 expression.There were no significant differences in gender,age,smoking,BMI,pathological type,Hb,PLR,LMR,ALB,hormone use,metastasis site,irAEs patients with PFS and OS(P>0.05).Conclusions:1.PD-L1 expression and Hb are related to the occurrence of irAEs in patients.When PD-L1 expression is positive and Hb<120 g/L,irAEs are more likely to occur,which are risk factors affecting the occurrence of irAEs in patients.2.PS score,tumor stage,antibiotic use,NLR and PD-L1 expression were associated with shorter survival time of patients.Higher PS score,stage Ⅳ tumor,use of antibiotics,NLR>3.17 and negative PD-L1 expression were the risk factors for the prognosis of immune checkpoint inhibitor treatment.