Relationship Between Inflammatory Markers And Prognosis In Advanced Non-small Cell Lung Cancer Patients Treated With First-Line EGFR-TKIs

Background and objective:Epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)have been extensively used in non-small cell lung cancer(NSCLC)patients.However,the prognosis biomarkers are limited.Inflammatory markers have been demonstrated to be associated with the prognosis in many solid tumors.This study aimed to assess the relationship between inflammatory indicators and the prognosis in advanced NSCLC patients treated with first-line EGFR-TKIsMaterials and Methods:A total of 236 advanced NSCLC patients who were treated with first-line EGFR-TKIs in the First Hospital of Jilin University from January 2017 to September 2019 were included in this retrospective analysis.The data of sex,age,smoking status,Eastern Cooperative Oncology Group(ECOG)score,histological types,EGFR mutation status,TNM stage,metastatic sites,tumor markers and blood routine were collected in this study.The cutoff value of each inflammatory index was determined by X-tile.The relationship between inflammatory indexes and clinical features was analyzed by chi-square test.Survival analysis was performed using Kaplan-Meier method and log-rank test.The univariate and multivariate Cox hazard regression analysis were performed to identify independent risk factors correlated with progression-free survival(PFS)Results:The cutoff value of neutrophil count(NEC),monocytes count(MOC),platelet count(PLTC),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and lymphocyte to monocyte ratio(LMR)was 3.78×109/L,188×109/L,0.50×109/L,3.18,131.01 and 3.20 respectively.NEC was correlated with age,sex,histological types,smoking status,cancer antigen(CA)125 and cytokeratin 19 fragments(CYFRA 21-1)(P<0.05).PLTC was correlated with T stage,CA125,CA199,carcinoembryonic antigen(CEA)and CYFRA 21-1(P<0.05).MOC was correlated with sex,lymph node metastasis,adrenal metastasis,CA724 and CYFRA21-1(P<0.05).NLR was correlated with sex,age,smoking status,M stage,lymph node metastasis,bone metastasis,CA125,CEA and neuron-specific enolase(NSE)(P<0.05).LMR was correlated with sex,lymph node metastasis,CA125 and NSE(P<0.05).All inflammatory indexes were related to PFS of patients(P<0.05),but only MOC and LMR were independent predictors of PFS.Furthermore,ECOG score,lymph node metastasis,M stage,liver metastasis and Cyfra21-1 were also independent predictors.A Nomogram model was constructed based on those independent predictors.The C-indices of the training and validation sets were 0.718 and 0.701,respectively.The calibration curves showed excellent consistency between the actual results and the nomogram predictionConclusion:The predictive value of MOC and LMR is superior to other inflammatory indicators.MOC and LMR are independent risk factors for the prognosis in advanced NSCLC patients treated with first-line EGFR-TKIs.This Nomogram model has good accuracy and credibility,which can act as an auxiliary tool to predict PFS of patients.