| Objective:The purpose of this study was to explore the relationship between pretreatment systemic immune-inflammation index(SII)and prognostic nutrition index(PNI)and the efficacy and prognosis of advanced non-small cell lung cancer(NSCLC)patients treated with programmed death-1(PD-1)inhibitors,and to provide guiding value for the beneficiary groups of non-small cell lung cancer patients who choose immunotherapy in the future.Methods:This study collected and analyzed clinical data on 121 advanced non-small cell lung cancer patients who received PD-1 inhibitor monotherapy at Nanchang University’s First Affiliated Hospital from September 2017 to March 2020,including sex,age,smoking status,ECOG score,tissue pathology type,tumor stage,treatment method and number of lines,metastasis,EGFR,ALK,ROS1 mutation status,immune-related adverse reactions etc.and collected all non-small cell lung cancer patients who have complete peripheral hematology-related indicators on the date of first visit or within 7 days prior to the start of immunotherapy,including peripheral neutrophil count,lymphocyte count,platelet count,serum albumin and so on.Based on the receiver operating characteristic(ROC)curve and the area under the curve(AUC),the optimal truncation values for predicting efficacy and prognosis of pre-immunotherapy SII,PNI and NLR were determined.According to the truncation value of SII/PNI/NLR,it was divided into two groups,the high-SII/PNI/NLR group and the low-SII/PNI/NLR group.The recent treatment responses of two groups of patients were evaluated according to the Solid Tumor Response Evaluation Standard(RECIST)version 1.1,and the differences between the objective response rate(ORR)and disease control rate(DCR)was analyzed and compared with Chi-square test.Survival analysis used Kaplan-Meier method for univariate analysis,log-rank test was used for inter-group difference comparison,and Cox proportional hazard regression for multivariate analysis.All data was statistically analyzed using SPSS25.0 software(SPSS,Inc.,Chicago,IL,USA).P<0.05,the difference was considered statistically significant.Results:Based on the receiver operating characteristic(ROC)curve and the area under the curve(AUC),the best truncation values for SII,PNI,and NLR were 611(sensitivity 0.71,specificity 0.69,AUC value 0.71),46.5(Sensitivity 0.77,specificity0.63,AUC value 0.71),3.87(sensitivity 0.83,specificity 0.60,AUC value 0.75).SII was divided into H-SII(SII≥611)group 58 cases and L-SII(SII<611)group 63 cases,PNI was divided into H-PNI(PNI≥46.5)group 62 cases and L-PNI(PNI<46.5)group59 cases,NLR was divided into H-NLR(NLR≥3.87)group 57 cases And L-NLR(NLR<3.87)group 64 cases.χ2 test showed that the ORR of H-SII group and L-SII group were 22.4% and 30.2% respectively(P=0.448),DCR was 48.3% and73.0% respectively(P=0.005);The ORR of H-PNI group and L-PNI group were 33.9%and 18.6% respectively(P=0.091),and the DCR was 72.6% and 49.2% respectively(P=0.014);The ORR of NLR group and L-NLR group were 24.6% and 28.1%respectively(P=0.657),while the DCR was 45.6% and 75.0% respectively(P=0.001).The results of univariate analysis showed that SII,PNI,NLR were associated with patients’ progression-free survival(PFS)and overall survival(OS)(P<0.05).The results of multivariate analysis showed that SII(HR=0.515,P<0.001),PNI(HR=1.999,P=0.005)and NLR(HR=0.171,P=0.040)were independent factors influencing the survival of advanced non-small cell lung cancer patients treated with immunotherapy.Moreover,PFS and OS were better in patients with two beneficial factors than patients with one or no favorable factors(P<0.001).Conclusion:For advanced NSCLC patients treated with PD-1 inhibitors,simple,economical and convenient hematological indicators such as SII,PNI can initially predict the efficacy and prognosis of patients,and help clinically select the benefiting population of immunotherapy. |
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