The Value Of Peripheral Blood Biomarkers For Predicting The Efficacy Of Sindilizumab In The Treatment Of Non-Small Cell Lung Cancer

Researchbackgroundandpurpose:Lung cancer is the most common tumor in China and even globally,and the incidence of non-small cell lung cancer(NSCLC)is 85%.Currently,conventional therapies for lung cancer are mainly surgery,chemotherapy and radiotherapy,while the advent of targeted therapies has led to significant improvement in NSCLC patients,but research on targeted therapies has been slow in NSCLC patients without tumor gene variants because of their poor prognosis.In recent years,with further understanding of tumor immunology and immune evasion mechanisms,high levels of PD-1 and PD-L1 expression in different types of cancer have been further validated.major breakthroughs in the use of PD-1 or PD-L1 inhibitors for the treatment of a variety of advanced tumors,including NSCLC.Numerous clinical trials have shown that the use of immune checkpoint inhibitors significantly improves survival in non-small cell lung cancer,and PD-1 or PD-L1 inhibitors are a standard therapy for NSCLC.However,due to the increasing size of current clinical trials,relevant studies have found that only 20% of patients with non-screening NSCLC can benefit from immune checkpoint inhibitors,and these patients may end up with recurrence or progression.The limited number of beneficiary groups and the high financial pressure of immunotherapy have exposed the difficulties in its practical use.Therefore,it is important to effectively enhance immune checkpoint inhibitors in NSCLC and to identify patients with potential from them to achieve better treatment outcomes.The main purpose of this paper is to investigate the impact of sindilizumab on the clinical outcome and prognosis of NSCLC patients and to explore its application to peripheral blood biochemical indices.The aim of this paper is to identify beneficial immunotherapies from routine blood tests in NSCLC patients,thus laying the foundation for individualized and accurate clinical application of NSCLC.Materialsand Methods:The clinical data of 52 patients with stage ⅢB and Ⅳ NSCLC treated with sindilizumab at the First Affiliated Hospital of Chengdu Medical College from September 2019 to December 2022 were retrospectively collected and analyzed,including patients’ clinical data and hematological indexes,to observe the changes of peripheral blood-related inflammatory indexes,tumor-related indexes and imaging changes of lesions in patients before and after PD-1 monotherapy,and to follow the The efficacy was evaluated according to the 2017 version of immunotherapy-related evaluation criteria for tumors(i RECIST).All data were statistically analyzed using SPSS 25.0 software(SPSS,Inc.,Chicago,IL,USA).The rank sum test was used to compare between-group differences in inflammatory indexes in NSCLC patients before treatment with sindilizumab,at optimal efficacy,and at disease progression.The optimal threshold values of inflammation-related indicators such as SII and tumor markers were calculated from the receiver operating characteristic curve(ROC).The Kaplan-Meier method was used to analyze the correlation between the above inflammation-related indexes and tumor marker parameters and the prognosis of stage IIIb-IV NSCLC patients.The univariate Cox proportional risk model was used to compare the correlation between patients’ baseline data and various hematological indicators and the outcome,and the factors that were statistically significant in the univariate analysis were applied to the Cox proportional risk regression model for multifactor analysis to screen out independent risk factors affecting the prognosis of NSCLC patients.The suspected influencing factors that were significant after single-factor analysis were also subjected to multifactor stepwise regression analysis,and those that were significant by multifactor analysis were independent influencing factors affecting the survival status of advanced NSCLC,and the difference was considered statistically significant at P<0.05.Result:1.The optimal cut-off values for SII,NLR,γ-GGT,LDH,FIB,CEA,and CYFRA21-1 were determined based on ROC and area under curve(AUC)of 996.39,4.41,274,34,4.05,and 3.29,7.2,respectively.area under curve(AUC)of ROC were0.71,0.80,0.51,0.69,0.59,0.65,and 0.60.2.High γ-GGT,FIB,SII,NLR,CYFRA21-1 and CEA by Kaplan-Meier analysis predicted poorer progression-free survival in NSCLC patients.3.The results of group comparison in rank sum test showed that the levels of inflammatory markers γ-GGT,LDH and FIB and tumor-related markers TK1,Hsp90α,CEA and NSE in peripheral blood were significantly lower when sindilizumab achieved optimal efficacy,but increased again with disease progression,and the differences were statistically significant(P<0.05).4.Cox univariate regression analysis showed that GGT,NLR,SII,FIB,CYFRA21-1 and CEA were all correlated with patients’ PFS(P<0.05).5.The results of Cox multi-factor stepwise regression analysis showed that four factors,NLR(P=0.027),SII(P=0.022),GGT(P=0.028)and CEA(P=0.028),were still retained in the model after stepwise regression adjustment,indicating that they were independent influencing factors on the prognosis of advanced NSCLC(P<0.05),and all of them were prognostic risk factors(HR>1).6.The results of Cox multi-factor regression analysis showed that NLR(HR=4.48,P=0.023)and γ-GGT(HR=3.68,P=0.014)were independent factors influencing the prognosis of immunotherapy survival in patients with advanced NSCLC.Conclusion:For patients with advanced NSCLC treated with PD-1 inhibitors,simple,cost-effective and convenient hematological indicators such as GGT,FIB,SII,NLR,CYFRA21-1 and CEA can help to predict patient outcome and prognosis early and provide a reference for clinical selection of beneficial immunotherapies.