Abstract

Background

The immune checkpoint inhibitors (ICI) in non-small cell lung cancer (NSCLC) had shown to increase progression-free survival (PFS) and overall survival (OS). The prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) are biomarkers easy to measure by blood tests and they had been studied as possible prognostic predictors in patients (pts) with various types of cancer treated with ICI. This study intends to analyze the impact of the NLR and PNI in pts with NSCLC treated with ICI.

Methods

Thirty-four pts with stage IV NSCLC that had started ICI in 1^st and subsequent lines between 03/2016 and 06/2019 were retrospectively analyzed. The pre-treatment NLR and PNI were calculated and the cut-off 5 and 50 were respectively considered. The Kaplan-Meier method and Log Rank test and the Cox regression were used in survival analysis.

Results

Twenty-seven (79%) were male, with a median age of 67 (34-79) years; ECOG 0-1 (n = 30; 88%); stage IVA (n = 14; 41%); PD-L1 ≥50% (n = 18; 53%); NLR ≥5 (n = 13; 38%); PNI ≥50 (n = 14; 41%). Eleven pts (32%) were submitted to ICI in 1^st line. The median follow-up time was 19,3 months (mo.). The median PFS was 6,1 mo. (95%CI 1,94-10,26) and median OS was 9,3 mo. (95%CI 0,31-18,29) - 16,5 mo. in 1^st line vs 8,6 mo. in subsequent lines. The median PFS was superior in patients with PNI ≥50 (7,0 vs 2,1 mo., p = 0,039), but there weren’t differences considering the NLR. The median OS was also superior when PNI ≥50 (16,8 vs 6,7 mo., p = 0,019). In multivariate analysis (sex, age, 1^st line, PD-L1, stage, ECOG, NLR and PNI), the mortality probability was superior in pts with ≥70 years [HR 6,14 (95%CI 1,49-25,39)]. Moreover, PD-L1 ≥50% [HR 0,09 (95%CI 0,01-0,52)], male sex [HR 0,03 (95%CI 0,004-0,24)], stage IVA [HR 0,26 (95%CI 0,07-0,997)] and PNI ≥50 [HR 0,15 (95%CI 0,03-0,69)] were associated to a reduced mortality risk.

Conclusion

PNI ≥50 was predictive of a better PFS and OS and the NLR wasńt a predictor of survival. Regarding OS, PNI ≥50 was an independent survival prognostic factor. In order to understand the impact of this biomarker in NSCLC treated with ICI, it is important to evaluate it in more studies with a larger population and prolonged follow-up time.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

中文翻译：

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19P免疫疗法治疗晚期非小细胞肺癌患者的预后营养​​指数和中性白细胞/淋巴细胞比是预后因素

抽象的

背景

非小细胞肺癌（NSCLC）中的免疫检查点抑制剂（ICI）已显示可增加无进展生存期（PFS）和总体生存期（OS）。预后营养指数（PNI）和中性白细胞与淋巴细胞比（NLR）是易于通过血液测试测量的生物标志物，并且已将它们作为ICI治疗的各种类型癌症患者（pts）的可能预后指标进行了研究。本研究旨在分析NLR和PNI对ICI治疗的NSCLC患者的影响。

方法

三十四个点IV期NSCLC的是曾在1开始ICI^第一和03/2016和06/2019之间后续行进行回顾性分析。计算了治疗前的NLR和PNI，分别考虑了临界值5和50。Kaplan-Meier方法和Log Rank检验以及Cox回归用于生存分析。

结果

男性为二十七（79％），中位年龄为67（34-79）岁；ECOG 0-1（n = 30; 88％）; IVA阶段（n = 14； 41％）；PD-L1≥50％（n = 18; 53％）; NLR≥5（n = 13; 38％）; PNI≥50（n = 14; 41％）。十一分（32％）在1条已提交给ICI^第一线。中位随访时间为19,3个月（mo。）。中位PFS为6.1 mo。（95％CI 1,94-10,26），中位操作系统为9.3个月。（95％CI 0,31-18,29）-16,5个月。在1^日线Vs 8,6 MO。在随后的几行中。PNI≥50的患者中位PFS更好（7.0相对于2.1个月，p = 0,039），但考虑到NLR并没有差异。当PNI≥50时，中位OS​​也较优（16,8 vs，6.7 mo。，p = 0,019）。在多元分析中（性别，年龄，^1st，PD-L1，阶段，ECOG，NLR和PNI），≥70岁的患者的死亡率较高[HR 6,14（95％CI 1,49-25,39）]。此外，PD-L1≥50％[HR 0,09（95％CI 0,01-0,52）]，男性[HR 0,03（95％CI 0,004-0,24）]，IVA期[HR 0,26（95％CI 0,07-0,997）]和PNI≥50[HR 0,15（95％CI 0,03-0,69）]与降低的死亡风险相关。

结论

PNI≥50可预示PFS和OS改善，而NLR则可预示生存。对于OS，PNI≥50是独立的生存预后因素。为了了解这种生物标志物在ICI治疗的NSCLC中的作用，重要的是在更多的研究中对其进行评估，这些研究具有更大的人群和更长的随访时间。

负责研究的法人实体

作者。

资金

尚未收到任何资金。

揭露

所有作者均声明没有利益冲突。