Study On The Correlation Between Peripheral Blood Indexes And The Prognosis Of Patients With Advanced Non-Small Cell Lung Cancer Treated With PD-1 Inhibitor Combined With Platinum-Containing Drugs

Objective: This study collected peripheral blood indicators such as routine blood tests,rapid biochemical tests,and tumor markers from patients with advanced nonsmall cell lung cancer who received PD-1 immunosuppressive therapy combined with platinum containing drugs before and after 2 cycles of treatment,and conducted a comprehensive evaluation of these indicators in combination with existing serological composite inflammatory nutrition indicators or scores,Explore whether such indicators can become prognostic biomarkers for PD-1 immunosuppressive agents combined with platinum containing drugs in the treatment of non-small cell lung cancer.Methods: To review and summarize the clinical data of patients with advanced non-small cell lung cancer who received PD-1 immunosuppressant combined with platinum-containing drug chemotherapy in the Second Hospital of Lanzhou University from January 2019 to December 2021.Including hospitalization number,nationality,gender,age,site,pathological type,TNM stage,whether radical surgery was performed,treatment plan,previous platinum-containing drugs use history,PS score,contact information,chest CT or chest enhanced CT,head CT or head MRI,abdominal color ultrasound or whole abdominal CT,whole body bone scan or PET-CT.Blood routine,rapid detection of biochemical complete items and tumor markers before and after 2 cycles of treatment.The values of LMR,NAR,NLR,PAR,PLR,PNI,SII and SIRI were calculated and scored according to the NPS scale and CONUT scale.SPSS25.0 software was used for statistical analysis.The statistical data were statistically expressed as the number of cases(%).Pearson Chi-square test or Fisher exact probability test was used to compare the categorical variables between groups.Multivariate Logistic model was used to analyze the prognostic factors affecting patients’ ORR and DCR,univariate and multivariate Cox proportional risk models were used to analyze the prognostic factors affecting patients’ DFS and OS,and KaplanMeier survival analysis was used to draw the PFS and OS survival curve of patients with advanced lung cancer and calculate the cumulative survival rate.The difference in survival rate was compared by log-rank test.P < 0.05 was considered statistically significant.Results: A total of 195 patients were included in this study.(1)Age,NSE,LMR and the difference value of MWR were independent risk factors for ORR(P<0.05),and age ≥65 years was associated with lower ORR.High NSE(OR=3.595,95%CI: 1.262-10.244),high LMR(OR=2.745,95%CI: 1.011-7.456),and increased MWR difference value group(OR=3.594,95%CI: 1.137-11.363)were associated with higher ORR.(2)NSE difference value was an independent risk factor for DCR(P<0.05),and increased NSE difference value group was associated with lower DCR(OR=0.384,95%CI:0.169-0.872).(3)Previous platinum use history and the difference value of white-bulb ratio were independent risk factors for PFS(P<0.05).Patients with a history of platinum use had a higher risk of disease progression(HR=1.727,95%CI:1.214-2.459),and patients with increased white-bulb ratio had a lower risk of disease progression(HR=0.560,95%CI:0.396-0.790).(4)TNM stage,PS score,white sphere ratio,LDH,the difference value of NSE,MWR difference value and the NPS score after treatment were independent risk factors for OS(P<0.05).Patients with TNM stage Ⅳ had a higher risk of death(HR=1.854,95%CI:1.156-2.975),patients with PS score 2 had a higher risk of death(HR=2.418,95%CI: 1.037-5.635),patients with increased white sphere ratio difference value group had a lower risk of death(HR=0.518,95%CI: 0.328-0.818),the high LDH group had a higher risk of death(HR=1.879,95%CI: 1.114-3.170),the increased NSE difference value group had a higher risk of death(HR=2.032,95%CI:1.256-3.287),the risk of death was lower in patients with increased MWR difference value(HR=0.592,95%CI: 0.351-0.998),the patients with NPS score>2 after treatment had a higher risk of death(HR=1.776,95%CI:1.004-3.140).(5)KaplanMeier survival curve analysis shows that: Patients with no prior platinum use had longer PFS than patients with prior platinum use(11.6 months VS 7.4 months),PFS were longer in the increased white sphere ratio defference group than in the decreased group(11.3 months VS 7.6 months).Patients with TNM stage Ⅲ had longer OS than patients with Ⅳ(26.6 months VS 15.7 months),patients with PS score 0-1 had longer OS than patients with PS score 2 months(22.8 months VS 7.2 months),and patients with white sphere ratio in high value group had longer OS than patients with low value group(26.6months VS 15.1 months).Patients with high LDH had shorter OS than patients with low LDH(14.7 months VS 22.8 months),patients with increased NSE difference value had shorter OS than patients with decreased MWR difference value(19.9 months VS24.4 months),and patients with increased MWR difference value had longer OS than patients with decreased MWR difference value(26.6 months VS 14.4 months).Patients with NPS score ≥2 after treatment had shorter OS than those with NPS score < 2(16.1months VS 36.2 months).Conclusions:(1)Age,difference of NSE,LMR and MWR were independent risk factors for ORR(P<0.05),and difference of NSE was independent risk factors for DCR(P<0.05).(2)Previous platinum-containing drugs use history and white-bulb ratio difference were independent risk factors for PFS(P<0.05).TNM stage,PS score,whitebulb ratio,LDH,NSE difference,MWR difference and post-treatment NPS score were independent risk factors for OS(P<0.05).