Prognostic value of inflammatory and nutritional indexes among advanced NSCLC patients receiving PD‐1 inhibitor therapy

Abstract

Though immunotherapy has to some extent improved the prognosis of patients with advanced non‐small cell lung cancer (NSCLC), only a few patients benefit. Furthermore, immunotherapy efficacy is affected by inflammatory and nutritional status of patients. To investigate whether dynamics of inflammatory and nutritional indexes were associated with prognosis, 223 patients were analysed retrospectively. The inflammatory indexes of interest were neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR) and systemic immune‐inflammation index (SII) while prognostic nutritional index (PNI) and the haemoglobin, albumin, lymphocyte and platelet (HALP) score were considered as nutritional indexes. Patients were divided into high and low groups or into ‘increase’ and ‘decrease’ groups based on pre‐treatment cut‐off values and index dynamics after 6‐week follow‐up respectively. High pre‐treatment PLR (OR = 2.612) and increase in NLR during follow‐up (OR = 2.516) were significantly associated with lower objective response rates. Using multivariable analysis, high pre‐treatment PLR (HR, 2.319) and increase in SII (HR, 1.731) predicted shorter progression‐free survival, while high pre‐treatment NLR (HR, 1.635), increase in NLR (HR, 1.663) and PLR (HR, 1.691) and decrease in PNI (HR, 0.611) predicted worse overall survival. The nomogram's C‐index in inside validation was 0.718 (95% CI: 0.670–0.766). Our results indicated both nutritional and inflammatory indexes are associated with survival outcomes. Inflammatory indexes were additionally linked to treatment response. Index dynamics are better predictors than baseline values in predicting survival in advanced NSCLC patients receiving PD‐1 inhibitor combined with chemotherapy as first‐line.

Prognostic role of the systemic immune-inflammation in patients with non-small cell lung cancer: a meta-analysis

“…16 studies with 2378 patients(16-18, 21,22,27,30,32,34,36,37,39,41,42,44,47) showed an association between the SII and PFS in NSCLC. Heterogeneity was signi cant (I 2 = 83.1%, P < 0.001), and a random-effects model was performed.…”

“…Numerous studies have investigated the prognostic signi cance of SII in NSCLC, but their results have been inconsistent . While some studies have identi ed SII as a crucial prognostic factor for NSCLC, others have not supported this view (41)(42)(43)(44). For instance, Soykut et al found that elevated SII was an independent prognostic marker for overall survival (OS) in NSCLC patients treated with chemoradiotherapy (hazard ratio [HR], 1.63; 95% con dence interval [CI], 1.18-2.04; p < 0.001) (36).…”

“…For instance, Soykut et al found that elevated SII was an independent prognostic marker for overall survival (OS) in NSCLC patients treated with chemoradiotherapy (hazard ratio [HR], 1.63; 95% con dence interval [CI], 1.18-2.04; p < 0.001) (36). However, in a recent study using multivariate analysis, Fang et al found that SII was not an independent prognostic factor for OS in patients with advanced NSCLC (HR, 1.140; 95% CI, 0.808-1.610; p = 0.445) (41). Therefore, to provide a more comprehensive and accurate evaluation of the prognostic role of SII in NSCLC patients, we conducted this meta-analysis.…”

Tertiary lymphoid structures combined with biomarkers of inflammation are associated with the efficacy of neoadjuvant immunochemotherapy in resectable non‐small cell lung cancer: A retrospective study

“…Inflammation induces leukocytosis, and the systemic immune-inflammatory index (SII), neutrophilto-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) can serve as inflammatory biomarkers and have been validated as diagnostic predictors in patients with lung and liver cancers receiving immunotherapy. 24,25 Therefore, we investigated the effects of inflammatory biomarkers (SII, PLR, NLR, and LMR) on TLS abundance and maturity of TLSs. We also compared the predictive values of these inflammatory parameters, TLSs, and the combination of inflammatory parameters with TLSs for immunotherapy efficacy in patients with NSCLC receiving neoadjuvant immunochemotherapy.…”

“…The systemic immune inflammatory index (SII) is based on a prognostic score of inflammation and immunity, which is calculated as platelet count*neutrophil count/lymphocyte count. Inflammation induces leukocytosis, and the systemic immune‐inflammatory index (SII), neutrophil‐to‐lymphocyte ratio (NLR), lymphocyte‐to‐monocyte ratio (LMR), and platelet‐to‐lymphocyte ratio (PLR) can serve as inflammatory biomarkers and have been validated as diagnostic predictors in patients with lung and liver cancers receiving immunotherapy 24,25 …”