The Effect Of Lymphocyte In Peripheral Blood And LAG-3 In Cancer Tissues On Prognosis Of Elderly Patients With Advanced Non-small Cell Lung Cancer

Objectives For elderly patients with untreated advanced non-small cell lung cancer(NSCLC),to investigate the effect of peripheral blood lymphocyte count and lymphocyte activation gene 3(LAG-3)expression in cancerous tissues and prognostic nutritional index(PNI)on the prognosis.Methods Total of 112 non-surgically treated NSCLC patients,with the age 60-80 years and diagnosis as stage IIIC-IV(according to the 2018 TNM staging criteria),from January 2015 to December 2018 were enrolled.Meanwhile,50 elderly healthy persons were recruited as normal controls.The LAG-3 expression was measured by immunohistochemistry and PNI was calculated based on peripheral blood lymphocyte count and serum albumin.The statistical analysis was performed by SPSS 26.0 and Graphpad Prism 6.0 software.Results 1 The lymphocyte count,PNI,and LAG-3 expression were significantly correlated with clinicopathological characteristics.The lymphocyte count,PNI,and LAG-3 expression were lower in NSCLC patients than healthy controls(P<0.05).The former two were related to age,TNM stage,the stage of lymph node metastasis and LAG-3 expression(P<0.05).Meanwhile,the positive expression rate of LAG-3 in cancer tissues was 47.3%(53/112).LAG-3 expression correlated with TNM stage,the stage of lymph node metastasis,lymphocyte count and PNI(P<0.05).2 the relationship between the three parameters and clinical efficacy,as well as prognosis,were explored.The clinical efficacy and overall survival(OS)in the NSCLC group were related to lymphocyte count,PNI,and LAG-3 expression.Lymphocyte count<1.43×10~9/L,PNI<46.11,and LAG-3 positive group had poorer efficacy.The total of 112 NSCLC patients had a median OS of 13.5 months,with 1,2,3,and 5 years survival rates of 62.5%,18.8%,9.8%,and 0.9%,respectively.Then,the median OS of lymphocyte count≥1.43×10~9/L group 16.0 months was higher than that of<1.43×10~9/L group 12.0 months.The 1,2,3,and 5 years survival rates were 76.8%,30.2%,16.0%,and 1.8%;50.0%,9.8%,6.0%,and0.0%in the two groups,respectively(χ~2=6.743,P=0.009).Median OS 17.5 months was higher in the PNI≥46.11 than in the PNI<46.11 group 10.0 months.The 1,2,3,and 5years survival rates were 80.4%,34.6%,20.8%,and 1.8%;46.3%,4.1%,0.0%,and 0.0%,respectively(χ~2=17.111,P<0.001);median OS 17.0 months was higher in the LAG-3expression-negative group than in the positive group 10.0 months,and the 1,2,3,and 5years survival rates were 78.0%,32.7%,17.6%,and 1.7%;47.1%,6.1%,4.1%,and 0.0%,respectively(χ~2=23.771,P<0.001).The univariate analysis showed that age,underlying disease,TNM stage,the stage of lymph node metastasis,treatments,lymphocyte count,PNI,and LAG-3 expression were associated with prognosis(P<0.05).Meanwhile,the Cox multivariate analysis showed that TNM stage,the stage of lymph node metastasis,PNI,and LAG-3 expression were independent prognostic factors in elderly patients with untreated advanced NSCLC.Conclusions Elderly patients with untreated advanced NSCLC have lower lymphocyte count and PNI than healthy controls,Both of them and LAG-3 expression are associated with TNM stage and lymph node metastasis grade.Patients with low lymphocyte count,low PNI,and positive LAG-3 expression have poorer treatment outcomes and prognosis.PNI,and LAG-3 expression are independent prognostic factors in elderly patients with untreated advanced NSCLC.Figure 5;Table 11;Reference 128...