The Value Of LIPI,ALI And IrAe In Evaluating The Efficacy And Prognosis Of Immunotherapy In Patients With Lung Adenocarcinoma In Stage Ⅳ

Objective:1.To explore the value of LIPI(immune prognostic index of lung cancer)and mLIPI(modified immune prognostic index of lung cancer)in evaluating the efficacy and prognosis of first-line immunotherapy in patients with lung adenocarcinoma in stage Ⅳ.2.To explore the value of ALI(inflammation index of advanced lung cancer)in evaluating the efficacy and prognosis of first-line immunotherapy in patients with lung adenocarcinoma in stage Ⅳ.3.To collect and investigate the irAE(immune-related adverse events)produced by first-line immunotherapy in patients with stage Ⅳ lung adenocarcinoma.And to explore the relationship between irAE and the prognosis of Ⅳ patients with lung adenocarcinoma treated with immunotherapy.Methods:1.The data of patients with stage Ⅳ lung adenocarcinoma who first received immunotherapy(immunecheckpointinhibitors,ICIs)in the Department of Respiratory and critical Care Medicine of Subei people’s Hospital from January 2019 to December2022 who met the inclusion and exclusion criteria were collected through the hospital information system HIS.The baseline clinical basic data of patients before immunotherapy were collected,including sex,age,body mass index(BMI),ECOG(Eeastern Cooperative Oncology Group)score,past history,smoking history,immunotherapy mode,metastasis site and number of metastasis sites.Baseline hematological indicators included white blood cells,neutrophils,lymphocytes,lactate dehydrogenase,albumin,etc.,as well as imaging data within one week before immunotherapy.The lung cancer immune prognostic index(Lung Immune Prognostic Index,LIPI)score and the modified lung cancer immune prognostic index(modified Lung Immune Prognostic Index,mLIPI)score were divided into two groups according to the results.The inflammatory index(advancedlungcancerinflammationindex ALI)of advanced lung cancer was calculated according to the formula,and grouped according to the best cut-off value of ALI.The curative effect was evaluated by hematology-related indexes,imaging examination and so on.All patients were followed up through outpatient clinic and telephone for disease progression,time of death,prognosis and so on.2.At the same time,the irAE of immune-related adverse events were collected to study the relationship between immune adverse reactions and prognosis of patients.Results:1.This study found that the types of immune-related adverse events were rash,immuneassociated pneumonia,immune-associated hepatitis,leukopenia,anemia,hypothyroidism,hyperglycemia,renal insufficiency,colitis and so on.Among them,immunotherapy-related rash is the most common.2.The AUC values of LIPI and mLIPI scores for predicting progression-free survival of lung adenocarcinoma in stage Ⅳ were 0.656(0.567-0.745)and 0.706(0.621-0.791),respectively,p<0.001,sensitivity 67.6%,82.4%,specificity 60%,54.3%.Higher LIPI and mLIPI scores were associated with worse progression-free survival.The AUC values of ALI for predicting the progression-free survival of Ⅳ lung adenocarcinoma were 0.759(0.676-0.841),p<0.001,the sensitivity was 85.7%,and the specificity was63.5% corresponding to the best truncation value 204.33U/L.Higher ALI was associated with better progression-free survival.Compared with LIPI and mLIPI scores,ALI is the most effective in predicting progression-free survival in immunotherapy patients with stage Ⅳ lung adenocarcinoma.3.The AUC values of LIPI and mLIPI scores for predicting the objective remission rate of immunotherapy for stage Ⅳ lung adenocarcinoma were 0.603(0.511-0.696)and0.628(0.537-0.720),respectively,p<0.001,the sensitivity was 63.5% and 77%,and the specificity was 55.7% and 48.6%,respectively.The higher the score of LIPI and mLIPI,the worse the objective remission rate.The AUC values of ALI score for predicting the objective remission rate of immunotherapy for stage Ⅳ lung adenocarcinoma were 0.688(0.601-0.771),p<0.001,sensitivity and specificity were78.6 and 59.5 respectively.The higher the ALI value is related to the better objective remission rate,which is better than LIPI and mLIPI,ALI in predicting the objective remission rate in patients with stage Ⅳ lung adenocarcinoma immunotherapy.4、The AUC values of LIPI and mLIPI scores for predicting the overall survival of immunotherapy for stage Ⅳ lung adenocarcinoma were 0.680(0.592 0.768)and 0.728 (0.646 0.810),respectively,with sensitivity of 67.9% and 79.8%,specificity of 65.0% and 56.7%.P<0.001.The AUC values of ALI for predicting the overall survival OS of immunotherapy for stage Ⅳ lung adenocarcinoma were 0.764(0.684-0.844),P<0.001,with a sensitivity of 85.1%,specificity of 67.7%,and approximately equivalency index of 0.517.The higher the ALI value,the better the progression free survival of stage Ⅳ lung adenocarcinoma patients with immunotherapy.Compared to the LIPI lung cancer immune prognosis index and the mLIPI modified version of lung cancer immune prognosis index,the ALI advanced lung cancer inflammation index has the best predictive effect on the overall survival of immunotherapy for stage Ⅳ lung adenocarcinoma patients.5、The survival analysis of progression-free survival and overall survival of patients with rash and non-rash in immunotherapy of stage Ⅳ lung adenocarcinoma showed that the p values were 0.037 and 0.046,respectively.The difference was statistically significant.This study found that immunotherapy-related rash was associated with a good prognosis of patients with stage Ⅳ lung adenocarcinoma after immunotherapy.Conclusion:1.This study found that LIPI lung cancer immune prognostic index,mLIPI modified lung cancer immune prognostic index and ALI advanced lung cancer inflammation index can be used to predict the prognosis of patients with Ⅳ lung adenocarcinoma immune checkpoint inhibitor.ALI advanced lung cancer inflammation index is the best in predicting progression-free survival and objective remission rate in immunotherapy patients with stage Ⅳ lung adenocarcinoma.2.This study found that there was a certain correlation between immunotherapy-related rash and the efficacy and prognosis of patients.The occurrence of immunotherapyrelated rash is associated with a good prognosis.