Peripheral blood white blood cells, monocytes, basophils, aspartate aminotransferase, and prothrombin time ratio after two cycles of treatment were independently associated with efficacy of neoadjuvant chemoimmunotherapy in non-small cell lung cancer

Abstract

Neoadjuvant chemoimmunotherapy (NCIO) is a new and effective treatment for cancer, but it is not clear for which patients it is suitable. In our previous study, we did not find any correlation between baseline peripheral blood routine tests and the efficacy of NCIO in non-small cell lung cancer (NSCLC). In this study, we aimed to investigate whether changes in these routine tests after treatment were associated with efficacy of NCIO in NSCLC. We retrospectively collected clinical data of patients with NSCLC who received NCIO followed by surgery from January 2019 to July 2022 at our institution.We included 95 patients with stage IIB-IIIC NSCLC. At week 6 after two cycles of NCIO, the absolute or changed values (or rates) in peripheral blood routine tests were associated with pathological complete response (pCR)/major pathological response (MPR). Changed rate of white blood cell (WBC) count [adjusted odds ratio (OR) = 5.24, P = 0.003] and changed rate of monocyte count (adjusted OR = 4.67, P = 0.017), and absolute prothrombin time ratio at week 6 (adjusted OR = 8.27, P = 0.012) were independently associated with pCR. Changed value of WBC count (adjusted OR = 4.23, P = 0.048), absolute basophil count at week 6 (adjusted OR = 5.05, P = 0.023), changed rate of monocyte count (adjusted OR = 4.37, P = 0.034) and absolute aspartate aminotransferase (AST) level at week 6 (adjusted OR = 15.78, P < 0.001) were independently associated with MPR. Based on the five independent factors, we established easy-to-use clinical models to predict pCR and MPR with area under the curve (AUC) values of 0.785 and 0.881, respectively. Of note, we found change' rate of monocyte count, absolute basophil count, AST and blood magnesium levels at week 6 may be promising biomarkers for NCIO in NSCLC. These peripheral blood routine tests at week 6 after NCIO were better predicted the efficacy of NCIO in NSCLC than at baseline. It is feasible to establish clinical predictive models through these parameters, and their predictive values were consistent with the pathological criteria of pCR and MPR.