To Investigate The Predictive Value Of Peripheral Blood NLR And Plasma Heat Shock Protein 90α For The Response To First-line Chemotherapy In Advanced Non-small Cell Lung Cancer

Objective: To analyze the feasibility of neutrophil-to-lymphocyte ratio(NLR)and heat shock protein 90α(HSP90α)in predicting the response to first-line chemotherapy in advanced non-small cell lung cancer(NSCLC)patients.Methods: A total of 60 patients with stage IIIB or IV non-small cell lung cancer admitted to the Department of Respiratory Medicine and Oncology of Shaoxing People’s Hospital from November 2021 to January 2023 were retrospectively analyzed.Routine blood test was performed on the day before chemotherapy,related indicators were recorded and NLR was calculated.Peripheral blood NLR,plasma HSP90α and other indicators were reexamined after four cycles of chemotherapy,and chest CT was performed at the same time to measure the changes of tumor lesions before and after chemotherapy.Disease remission was evaluated according to RECIST1.1 criteria and divided into chemotherapy effective(CR,PR,SD)and chemotherapy ineffective(PD).According to the ROC curve,the patients were divided into high NLR group(≥2.94)and low NLR group(<2.94),and HSP90α high level group(≥0.425)and HSP90α low level group(<0.425);The correlation between NLR and HSP90α levels before treatment and the efficacy of chemotherapy in the two groups were analyzed,and the dynamic changes of NLR and HSP90α levels before and after treatment were analyzed.SPSS22.0 was used to analyze the data.Results: 1.There was no significant correlation between NLR and plasma HSP90α level and gender,age,TNM stage,performance status,pathological type,smoking history,distant metastasis(P>0.05);2.ROC curve analysis showed that the best cut-off values of NLR and HSP90α before chemotherapy to predict the efficacy of patients were 2.94 and 0.425,the corresponding sensitivity were 82.4% and 82.4%,the specificity were 76.7% and 62.8%,and the area under the curve were 0.773 and 0.718(P<0.05),indicating that both of them had statistical significance in predicting the efficacy of chemotherapy.When NLR and HSP90α were combined,the corresponding AUC was 0.791,the sensitivity was 82.4%,and the specificity was 74.4%,indicating that the predictive value of the combination of the two was higher than that of NLR or HSP90α alone.3.After four cycles of treatment,the disease control rate in the high NLR group was41.7%,which was significantly lower than 91.7% in the low NLR group,and the disease control rate in the high HSP90α group was 50.0%,which was significantly lower than 93.3%in the low HSP90α group(P<0.05).4.The disease control rate(DCR)of the significantly increased group was 56.0%,which was significantly lower than 82.9% of the not significantly increased group(P<0.05).5.The levels of HSP90α,D-dimer and Hb after chemotherapy were significantly lower than those before chemotherapy(P<0.05),CEA had no significant change.In the response group,HSP90α,D-dimer and Hb decreased significantly after chemotherapy(P<0.05);In the chemotherapy-ineffective group,the decrease of HSP90α and D-dimer after chemotherapy was not statistically significant(P>0.05),Hb decreased significantly(P<0.05),CEA had an upward trend,but the difference was not statistically significant(P> 0.05).6.ROC curve analysis showed that the best cut-off values of NLR and HSP90α after chemotherapy to predict the efficacy of patients were 2.88 and 0.432,and the corresponding specificities were 51.2% and 97.7%,respectively.The sensitivity was 94.1% and 70.6%,and the AUC was 0.736 and 0.842(P<0.05);The area under the ROC curve of NLR and HSP90αwas lower than that of the combination of NLR and HSP90α,indicating that the combined detection of NLR and HSP90α had a high predictive value.Conclusion: The levels of NLR and HSP90α in peripheral blood and their dynamic changes during treatment have certain predictive value for the response to chemotherapy in advanced NSCLC.