Correlation Study Of Serum Lipid Level,Prognostic Nutrition Index And Efficacy Of PD-1/PD-L1 Inhibitor In Treatment Of Non-Small Cell Lung Cancer

ObjectiveThis study was a retrospective analysis of 104 patients with advanced non-small cell lung cancer treated with PD-1/PD-L1 inhibitors to investigate the correlation between lipid levels(total cholesterol,triglycerides,HDL cholesterol,LDL cholesterol)and prognostic nutritional indices and the outcome of patients with advanced NSCLC treated with PD-1/PD-L1 inhibitors.MethodsThe data of 104 patients with advanced NSCLC treated with PD-1/PD-L1inhibitors from August 2019 to December 31,2022 at the Oncology Center,Department of Respiratory Medicine and Department of Thoracic Surgery of the Second Hospital of Lanzhou University were collected according to the nadir criteria,including:(i)clinical characteristics:name,gender,age,body mass index(BMI),tumor pathology(1)clinical characteristics:name,gender,age,body mass index(BMI),tumour pathology,tumour type,TNM stage,number of treatment lines,PD-1/PD-L1 inhibitor regimen(monotherapy and combination therapy),type of PD-1/PD-L1 inhibitor;(2)laboratory parameters:Total cholesterol,triglyceride,high density lipoprotein(HDL)cholesterol before and after 4 cycles of immunotherapy.Total cholesterol,triglyceride,high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C),plasma albumin level,peripheral blood lymphocyte count before and after 4 cycles of immunotherapy,and calculation of prognostic nutritional index(PNI).Prognostic nutritional index(PNI)=plasma albumin(g/L)+5 x absolute value of total lymphocyte count(×10~9/L);(3)Imaging data:CT of chest and abdomen before and after 4 cycles of immunotherapy,MRI of head,bone scan,PET-CT,etc.The efficacy of the patients was evaluated comprehensively according to the efficacy evaluation criteria for solid tumours in version 1.1.Progression free survival(PFS)was used as the primary study endpoint for this study.The data collected were grouped according to specific criteria and the differences between the objective response rate(ORR)and disease control rate(DCR)were compared by chi-square test;Kaplan-Meier curves were plotted and Log Rank test was used to compare the differences in PFS between the different groups.The differences in PFS between the different groups were compared by plotting Kaplan-Meier curves and using Log Rank test;multifactorial analysis was performed by Cox proportional risk regression model;paired t-test was used to investigate the trends in lipid levels and PNI before and after treatment with PD-1/PD-L1 inhibitors.All data were analysed by SPSS25.0 software and differences were considered statistically significant at P<0.05.Results1.TC in lipid levels were divided into 51 cases in the H-TC(TC≥5.3)group and 53 cases in the L-TC(<5.3)group,TG into 28 cases in the H-TG(TG≥1.7)group and 76 cases in the L-TG(TG<1.7)group,HDL-C into 62 cases in the H-HDL-C(≥1.0)group and 42 cases in the L-HDL-C(<1.0)group,LDL-C was divided into 13cases in the H-LDL-C(≥3.4)group and 91 cases in the L-LDL-C(<3.4).χ2 test showed that the ORR was 35.5%and 16.7%in the H-HDL-C and L-HDL-C groups,respectively(P=0.036),indicating that the ORR of HDL-C in blood lipid levels differed between different groups(P<0.05).2.PNI was divided into 66 cases in the H-PNI(PNI≥45.925)group and 38cases in the L-PNI(<45.925)group.χ2 test showed that the DCR was 87.9%and65.8%in the H-PNI and L-PNI groups respectively(P=0.007),indicating that there was a difference in DCR between different groups of PNI(P<0.05).3.Results of univariate analysis:There was a significant correlation between tumour TNM stage,TC and PNI and patients’PFS(P<0.05).Results of multi-factor analysis:tumour TNM stage(HR=1.019,P=0.038)and PNI(HR=0.421,P<0.001)were independent influencing factors in predicting survival prognosis of immunotherapy patients with advanced NSCLC.4.Changes in lipid levels and PNI before and after immunotherapy:After 4cycles of immunotherapy,the TG and LDL-C levels in lipid levels increased(P=0.042&P=0.021)and TC levels decreased(P=0.006)compared to before immunotherapy,while the changes in HDL-C levels and PNI before and after immunotherapy were not statistically significant(P>0.05).Conclusions1.Patients with higher levels of high-density lipoprotein cholesterol(HDL-C)and prognostic nutritional index(PNI)had better near-term outcomes in NSCLC,which could be a reference indicator for predicting the selection of a superior population for NSCLC treated with PD-1/PD-L1 inhibitors.2.Patients with low levels of total cholesterol(TC),high levels of PNI,and TNM stage III had better long-term outcomes than those with TNM stage IV NSCLC.