| Objective: To investigate the correlation between peripheral blood parameters and the efficacy of pembrolizumab combined with platinum-based doublet-chemotherapy in patients with advanced non-small cell lung cancer(NSCLC).Methods: Patients with NSCLC who received first-line pembrolizumab combined with platinum-based doublet-chemotherapy from October 31,2019 to June 31,2022 were included in this study.The baseline data of patients were collected,including age,gender,smoking history,pathology,TNM stage,ECOG score,PD-L1 TPS,external thoracic metastasis,ir AEs,NLR and LDH.Patients were divided into high NLR group and low NLR group according to the median NLR value,and high LDH group and low LDH group according to the upper limit of normal LDH value.ORR and DCR were compared between groups by chi-square test or exact Fish test.The Kaplan-Meier method was used for univariate analysis and survival curve was drawn,and the log-Rank test was used to evaluate the differences between groups.Cox proportional hazards regression model was used for multivariate analysis.A P value of less than 0.05 was considered statistically significant.All data were processed by SPSS 26 software.Results: 1.A total of 50 NSCLC patients who received first-line pembrolizumab combined with platinum-based doublet-chemotherapy were collected.Ten patients were excluded due to missing baseline data,missing imaging data and other reasons,and a total of 40 patients were included for analysis.Among the patients,37 were male and 3were female.The age ranged from 28 to 81 years,with a median age of 68.5 years.There were 16 patients aged ≥70 years and 24 patients aged <70 years.There were30 smokers,10 non-smokers,31 squamous cell carcinoma patients and 9adenocarcinoma patients.There were 19 patients in stage III and 21 patients in stage IV.There were 15 patients with ECOG score 0 and 25 patients with ECOG score 1.There were 14 patients with a PD-L1 expression of 1%-49%,8 patients with a PD-L1 expression of 50% or more,and 18 patients with unknown PD-L1 expression.There were 30 patients without external thoracic metastasis,10 patients with external thoracic metastasis,including 7 patients with bone metastasis,1 patient with brain metastasis,3patients with liver metastasis,and 1 patient with liver metastasis combined with bone metastasis.There were 14 patients with ir AEs and 26 patients without ir AEs.There were 20 patients in the high NLR group and 20 patients in the low NLR group.There were 13 in the high LDH group and 27 in the low LDH group.2.Among the 40 patients,3 patients(7.5%)achieved CR,18 patients(45%)achieved PR,16 patients(40%)achieved SD,and 3 patients(7.5%)achieved PD.The median follow-up time was 17 months(95%CI: 15.27-18.73).The m PFS and m OS were 8.57 months(95%CI: 5.90-11.24)and 19.9 months(95%CI: 11.61-28.19),respectively.3.The ORR of patients with high NLR and low NLR were 30% and 75%,respectively,and the difference was statistically significant(P=0.004).The DCR of the two groups was 90% and 95%,respectively,and the difference was not statistically significant(P=1.000).The ORR of patients in the high LDH group and the low LDH group was 46.2% and 55.6%,respectively,and the difference was not statistically significant(P=0.577).There was no significant difference in DCR between the two groups(92.3%VS92.6%,P =1.000).4.Univariate analysis showed that NLR,LDH,TNM stage and external thoracic metastasis were related to PFS(P < 0.05).NLR,gender,TNM stage,and external thoracic metastasis were associated with OS(P<0.05).5.Multivariate analysis showed that NLR and TNM stage were independent predictors of PFS and OS(P<0.05).Conclusion:1.NLR is associated with ORR in NSCLC patients receiving first-line pembrolizumab combined with platinum-based doublet-chemotherapy,and a lower NLR may have better short-term efficacy.2.In NSCLC patients treated with first-line pembrolizumab combined with platinum-based doublet-chemotherapy,a lower NLR before treatment and a lower TNM stage are associated with better PFS and OS. |
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