Predictive Value Of Peripheral Hematological Indicators In First-Line Immunotherapy For Extensive Small-Cell Lung Cancer Patients

Objective:To explore The complex indexes derived from peripheral blood serological indexes,including The neutrophil/lymphocyte ratio(NLR),The platelet to lymphocyte ratio,PLR),systemic immune-inflammation index,SII)and advanced lung cancer inflammation index(ALI)predicted the prognostic value of patients with extensive small cell lung cancer(SCLC)receiving first-line immunotherapy.Statistical software was used to analyze the relationship between the indicators and the survival indicators of patients,in order to provide reliable and economic prognostic indicators for the prognosis of small cell lung cancer patients receiving first-line immunotherapy.Methods:Patients admitted to the *********** from January 2017 to June 2022 who were diagnosed with extensive SCLC based on pathological and imaging data were collected through the medical record system,and the clinical characteristics data table of the research object was constructed,including gender,age,physical fitness score,smoking history,Body Mass Index(BMI).Body mass index),treatment plan of first-line immunotherapy,peripheral blood cell analysis before treatment,blood biochemistry,tumor markers,etc.,PLR,NLR,SII,ALI values were calculated according to the corresponding formula.the Area under the curve(AUC)of Receiver operating characteristic curve(ROC)drawn in SPSS software was used to determine the diagnostic value of the study indicators.Using the sensitivity and specificity results,the Yoden index was calculated to obtain the best cut-off value and divided into high and low groups.Progression-free PFS and overall survival OS were recorded for all patients in groups.Chi-square test was used to observe the differences among the groups.Then Kaplan-Meier method in the software was used for single factor survival analysis and survival curve was drawn,which was corrected by log-rank test.Identify the factors that influence the efficacy of immunotherapy;Multivariate analysis of COX regression was performed to determine the independent prognostic factors of PFS or OS.P<0.05 was considered to be statistically significant.Results:(1)A total of 68 cases were collected according to inclusion criteria and exclusion criteria.Zero cases were lost to follow-up.(2)ROC curve determined that the optimal cut-off value of NLR for predicting the prognosis of patients was 7.29(P=0.042),and NLR was divided into low group(62 cases)and high group(6 cases)according to the cut-off value.The best truncation value of PLR in predicting the prognosis of patients was 588.78(P=0.040).According to the truncated value,PLR was divided into low group(42 cases)and high group(26 cases).The optimal cut-off value of SII in predicting the prognosis of patients was 254.02(P=0.047).According to the cut-off value,SII was divided into low(57 cases)and high(11 cases)groups.The optimal cut-off value of ALI in predicting the prognosis of patients was 31.24(P=0.033).ALI was divided into low group(25 cases)and high group(43 cases)according to the cut-oflf value.(3)The comparison of the short-term efficacy of patients with different NLR,PLR,SII and ALI showed that the DCR in the high NLR group was significantly higher than that in the low group(83.33%and 44.19%,respectively,P=0.001).In the PLR group,the ORR values(19.23%and 7.14%,respectively,P=0.012)and DCR values(19.23%and 7.14%,respectively,P=0.001)in the high group were significantly higher than those in the low group.The DCRS in the SII group were significantly higher in the high group than in the low group(45.45%and 33.33%respectively,P=0.001).(4)Univariate analysis showed that smoking,NLR PLR SII,ALI,ProGRP and NES levels were correlated with OS(P=0.026,0.005,0.005,0.007,0.043,0.033,0.026,respectively).Smoking status,BMI,NLR PLR SII,ALI,ProGRP and NES levels were correlated with OS(P=0.016,0.016,0.048,0.034,0.031,0.006,0.018,0.039,respectively).(5)COX multivariate analysis showed that smoking(HR:4.043,95%CI:1.286-12.709;p=0.017),SII level(HR:2.764,95%CI:1.194-6.399;p=0.018)was an independent prognostic factor associated with smoking in PFS(HR:4.543,95%CI:1.265-16.320;p=0.020),ProGRP(HR:4.080,95%CI:1.218-6.371;p=0.049)and SII(HR:3.677,95%CI:1.263-10.704;p=0.017)level was an independent prognostic factor associated with it.The actual survival of patients at 12 months was consistent with the predicted probability.After calibration,the C-index value was 0.773(95%CI,0.681-0.865),and the C-index value was>0.7,indicating that the prediction value of the model was medium.Conclusion:(1)The initial inflammation level of patients is correlated with the efficacy of immunotherapy.High NLR,high PLR,high SII,and low ALI suggest that the efficacy of first-line chemotherapy combined with immunotherapy is poor.(2)Smoking,BMI,NLR,PLR SII,ALI,ProGRP and NES levels were correlated with the prognosis of SCLC patients,and smoking and SII levels were independent predictors of SCLC patients.(3)The indexes of NLR,PLR,SII and ALI can be used as simple and economical serological indexes for patients with extensive small cell lung cancer to participate in predicting the efficacy of immunotherapy and help clinicians optimize the population benefiting from immunotherapy.In the future,it may be considered to further combine TMB and other indexes to help guide clinical work.