Effect And Prognostic Factors Of First-line Immunotherapy For Advanced Driver Gene-negative Non-small Cell Lung Cancer

ObjectiveThis study retrospectively analyzed the clinical characteristics,prognostic and related risk factors of patients with advanced driver gene-negative non-small cell lung cancer who received immunotherapy with the immune checkpoint inhibitor in the first-line clinical work.To explore the real-world effects of immunotherapy and related influencing factors in patients with advanced NSCLC.MethodsThe clinical data of patients with advanced driver gene-negative NSCLC who received immunotherapy for the first-line in the First Affiliated Hospital of Dali University from January 2019 to June 2022 were collected.The collected data mainly include:general characteristics,clinical data,follow-up information,blood routine before treatment,C-reactive protein,serum albumin concentration.Calculation of CRP/ALB ratio,absolute value of granulocytes(N)and absolute value of lymphocytes(L)count ratio(NLR),modified Glasgow prognostic score(m GPS),prognostic nutritional index(prognostic nutritional index,PNI),systemic immune inflammation index(Systemic immune-inflammation index,SII),advanced lung cancer inflammatory index(ALI).Optimal cut-off values for CRP/ALB,NLR,SII,PNI,ALI were determined using receiver operating characteristic curves(ROC),survival curves were drawn by Kaplan-Meier.Cox proportional hazards regression models were used to perform univariate and multivariate analyzes to determine the prognostic factors associated with the disease.Statistical analysis was performed using SPSS 26.0 statistical software.Statistically significant was set at P<0.05.Results1.A total of 45 patients with advanced driver gene-negative NSCLC patients receiving first-line immunotherapy were included,with a median PFS of 10.7 months(95%CI:6.01-15.40),and median OS of 12.5 months(95%CI:5.70-19.31).Theχ~2test results indicated that female patients and patients with no smoking history had a higher ORR(66.67%vs.19.44%,P=0.005,53.85%vs.18.75%,P=0.019).2.Univariate analysis showed that CRP/ALB,NLR,PNI,SII,and ALI were correlated with patients’median PFS(P<0.05),and CRP/ALB,NLR,SII,and ALI were correlated with patients’median OS Sex(P<0.05).Multivariate analysis showed that ALI was an independent prognostic factor for median PFS(HR:0.164,95%CI:0.030-0.904,P=0.038),and SII was an independent prognostic factor for median OS(HR:5.205,95%CI:1.534-17.652,P=0.008).3.The multivariate model showed that the median PFS of group A with 2 favorable factors was 18.7 months(95%CI:15.909-21.491),and the median PFS of group B with 1favorable factor was 14.13 months(95%CI:2.236-26.024),the median PFS of group C without favorable factors was 8.4 months(95%CI:3.716-13.084),and the prognosis of group A was significantly better than that of the other two groups(P=0.017).Conclusion1.The median PFS of first-line immunotherapy for patients with advanced negative driver gene NSCLC is 10.7 months,and the median OS is 12.5 months.Among them,20%of immune-related adverse reactions,It’s tolerable.2.The levels of CRP/ALB,NLR,PNI,SII,and ALI before treatment are significantly related to the efficacy of immunotherapy,among which SII and ALI are independent prognostic factors.The multivariate model shows that the median PFS of patients with high ALI and low SII are significantly prolonged.It can assist in assessing whether the patient is a beneficiary group and has certain clinical value.