Clinical Value Of PD-L1 Expression And Peripheral Blood Routine After Immunotherapy In Patients With Wild-type Advanced Non-small Cell Lung Cancer

Backgound: Lung cancer is the malignant tumor with the highest incidence and mortality rate in the world.Non-small cell lung cancer(NSCLC)is the majority.Beside chemotherapy and targeted therapy,immunotherapy has gradually become one of the effective drug treatment for patients with advanced lung cancer.However,not all patients can prolong their lives and improve their quality of life through immunotherapy,and only about one-third of patients can get longer survival.In addition,immunotherapy is expensive and may cause adverse reactions.Therefore,it is necessary to accurately choose suitable patients to receive immunotherapy.It is controversial for programmed cell death-ligand 1(PD-L1)as a biomarker to predict the prognosis of immunotherapy.There are some differences in the prognostic significance of PD-L1 in the different studies.It is necessary to prove its prognostic value through experimental research.In recent years,studies have shown that the inflammatory indicators in the peripheral blood are related to the prognosis of tumors.Neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and lymphocyte to monocyte ratio(LMR),as the inflammatory complex indexes,may be related to the curative effect of therapy.Objective: To investigate the correlation of the peripheral blood inflammatory complex indexes,PD-L1 expression and the curative effect of immunotherapy combined with chemotherapy in patients with advanced NSCLC and negative driven genes.Methods: 65 advanced NSCLC patients with negative driven genes who underwent chemotherapy and immunotherapy combined with chemotherapy from Anhui Provincial Hospital from January 2018 to October 2020 were retrospectively analyzed.Clinical data were collected.The correlation between various indicators were calculated and analyzed among followed-up patients.Results: Pre-therapy PD-L1 expression was correlated with pathology(P=0.030),while it was not significantly correlated with the curative effect of immunotherapy.Pretherapy LMR levels were related to age and distant metastasis(P=0.035,P=0.032).Compared with patients who underwent chemotherapy,the higher response rate(43.8%vs.18.2%,P=0.026)and longer PFS(7.7m vs.4.7m,P=0.009)were observed in patients who underwent immunotherapy combined with chemotherapy.However,the incidence of adverse reactions is similar between the two treatments.For patients who received chemotherapy,male,with less distant metastasis(<3),increasing PLR level after therapy,high LMR level before therapy had longer PFS(P < 0.05).However,patients with reducing PLR level after immunotherapy combined with chemotherapy presented longer PFS(P=0.014).Gender(HR=4.22,95%CI:1.13-15.75,P=0.032),the change of PLR level after therapy(HR=0.34,95%CI:0.14-0.79,P=0.013)and LMR level before therapy(HR=0.45,95%CI:0.21-0.97,P=0.041)were independent prognostic factors for PFS of patients with chemotherapy,while the change of PLR level was identified as an independent prognostic factor for PFS of patients who underwent immunotherapy combined with chemotherapy.Conclusion:Pre-therapy PD-L1 expression is correlated with pathology while it is difficult to predict the efficacy of immunotherapy.Pre-therapy LMR levels are related to age and distant metastasis.The response rate and PFS of patients with advanced NSCLC and negative driven genes are improved after immunotherapy combined with chemotherapy.The peripheral blood inflammatory complex indexes are related to the curative effect of therapy in the advanced NSCLC patients to a certain extent.