Prognostic Value Of Peripheral Blood Platelets And Leukocytes In Patients With Advanced Non-small Cell Lung Cancer Treated With PD-1 Inhibitors

Objective: The purpose of this study was to investigate the relationship between platelet-to-white blood cell ratio(PWR),platelet-to-lymphocyte ratio(PLR),and neutrophil-to-lymphocyte ratio(NLR)and prognosis in patients with advanced non-small cell lung cancer(NSCLC)treated with PD-1 inhibitors.Methods :(1)the selection between August 2018 and December 2020 Yu Guilin medical school affiliated hospital and oncology,respiratory medicine,treatment of thoracic surgery,the daytime zone hospital treatment of advanced non-small cell lung cancer patients,all patients for the first time in our PD-1 inhibitor treatment,through the guilin medical college affiliated hospital medical record management system in patients with information collection,The data included gender,age,site of disease,pathological classification,TNM stage,number of distant metastatic sites,smoking,alcohol consumption,whether radical surgery was performed,treatment plan,number of treatment line and previous use history of platinum.Blood routine indexes including platelets,white blood cells,neutrophils,and lymphocytes were collected within two weeks before the first treatment with PD-1 inhibitors.(2)According to the review data of patients,the efficacy of patients was evaluated,the disease control rate and objective remission rate of all patients were calculated,and the progression-free survival(PFS)of patients with disease progression and the truncation period of patients without disease progression were calculated.(3)All the statistical results were analyzed using SPSS 25.0 software.The mean ± standard deviation was used to represent the measurement data,the number of cases and the percentage were used to represent the enumeration data,and the chi-square test was used to compare between groups.Progression-free survival rate was calculated by Kaplan-Meier method,and a curve was drawn.Some curves were drawn by Prism software.The survival differences between different groups were compared by Log-rank test,and prognostic factors were analyzed by Cox regression.Results:(1)From August 2018 to December 2020,a total of 225 patients met the inclusion criteria,22 were lost to follow-up,29 were excluded because they did not return to the hospital for review and could not evaluate the efficacy,and 174 cases were included in this study.(2)There were significant differences in N staging(P=0.004),M staging(P=0.023),TNM staging(P=0.023)and smoking(P=0.033)between the high PWR group and the low PWR group.There were statistically significant differences in alcohol consumption(P=0.014),radical surgery(P=0.035)and treatment plan(P=0.019)between the high PLR group and the low PLR group.There were significant differences in T stage(P=0.004),M stage(P=P=0.029),TNM stage(P=0.029),the number of distant metastasis sites(P=0.048),smoking(P=0.001)and the number of treatment plan lines(P=0.039)between the high NLR group and the low NLR group.(3)Among the evaluable cases,CR 0 cases(0.00%),PR 49cases(28.16%),SD 92 cases(52.88%),PD 33 cases(18.97%).A total of 141 patients achieved disease control,with a total DCR of 81.03%,and 49 patients achieved objective response,with a total ORR of 28.16%.(4)At the end of the follow-up on December 31,2020,a total of 174 patients were included in this analysis,101 of them reached the end of the study and 73 of them had their tails truncated.Among them,the shortest PFS was 0.6 months,the longest was 18.7months,and the total median PFS was 5.02 months(95%CI:4.050-7.155).Among them,the 6-month and 1-year PFS of 75 patients in the high-value PWR group were 50.1% and 42.42%,and the 6-year and 1-year PFS of 99 patients in the low-value PWR group were 52.0% and 46.47%,respectively.The 6-month and 1-year progression-free survival rates(PFS)of 63 patients in the high-value PLR group were 44.44% and 38.10%,and the 6-year and 1-year PFS of 111 patients in the low-value PLR group were 54.05% and 47.75%,respectively.The6-month and 1-year progression-free survival rates were 42.11% and 40.35% in the high-value NLR group(n = 57),and 54.70% and 46.15% in the low-value NLR group(n = 117).Progression-free survival(PFS)was calculated by Kaplan-Meier method,and the differences between the different groups were compared by Log-rank test.Patients in the low-PLR group had a significantly longer median PFS(PFS=3.94 months vs.5.65 months;X2 = 9.573,P = 0.002);Patients in the low-NLR group had significantly longer median PFS in the high-NLR group(PFS=3.65 months vs.5.69 months;X2 = 8.239,P = 0.004).(5)Univariate analysis results showed that PLR(P=0.002),NLR(P=0.005),M staging(P=0.017),TNM staging(P=0.017),the number of metastatic sites(P=0.027),alcohol consumption(P=0.039),and the number of treatment regimens(P=0.042)were risk factors for progression-free survival of NSCLC patients(P< 0.05).(6)Multivariate analysis showed that PLR(P=0.022),M stage(P=0.028),TNM stage(P=0.028)and alcohol consumption(P=0.042)were independent influencing factors for the prognosis of NSCLC patients treated with PD-1 inhibitors.Conclusions:(1)The prognosis of patients in the high PLR group and the high NLR group was worse than that in the low PLR group and the low NLR group.(2)PLR,NLR,M stage,TNM stage,the number of metastatic sites,alcohol consumption,and the number of treatment regimens were related to the progression-free survival.(3)PLR,M stage,TNM stage and alcohol consumption were independent influencing factors for the prognosis of NSCLC patients.