Analysis Of The Relationship Between Peripheral Blood Markers And The Outcome Of Patients With Advanced Non-small Cell Lung Cancer After Anti-PD-1 Immunotherapy

Purpose:To explore the predictive value of pretreatment neutrophil/lymphocyte ratio(NLR),lactate dehydrogenase(LDH)and prognostic nutrition index(PNI)in patients with advanced NSCLC treated with anti-PD-1 antibodies.Methods:We retrospectively analyzed 102 advanced NSCLC patients treated with PD-1 inhibition at the First Affiliated Hospital of Nanchang University from January 2017 to May 2019.According to the distribution features of NLR,LDH and PNI,We divided patients into High-NLR(H-NLR),Low-NLR(L-NLR)groups,High-LDH(H-LDH),Low-LDH(L-LDH)groups and High-PNI(H-PNI),Low-PNI(L-PNI)groups.Chi-square test was used to compare the difference of the objective response rate(ORR)and disease control rate(DCR)of each group.Comparison of progression free survival(PFS)and overall survival(OS)were performed by Kaplan-Meier curves and log-rank tests.Independent prognostic factors of PFS and OS were analyzed by multivariate Cox proportional hazard models.Results:The cases of patients in H-NLR(NLR ?5)and L-NLR(NLR <5)groups were 58 and 44,respectively.The cases of patients in H-LDH(LDH ?240 U/L)and L-LDH(LDH <240 U/L)groups were 69 and 33,respectively.And the cases of patients in H-PNI(PNI ?45)and L-PNI(PNI <45)groups were 55 and 47,respectively.The chi-square test showed that ORR of H-NLR and L-NLR groups were 25.8% and 29.5% respectively(P=0.680),DCR of the two groups were 48.3% and 72.7% respectively(P =0.013).The ORR of H-LDH and L-LDH groups were 24.6% and 27.3% respectively(P =0.775),DCR of the two groups were 56.5% and 63.6% respectively(P =0.495).Moreover,the ORR of H-PNI and L-PNI groups were 29.1% and 21.3% respectively(P =0.367),DCR of the two groups were 61.8% and 55.3% respectively(P =0.506).Univariate analysis showed that NLR,LDH and PNI were factors influencing the PFS and OS(P <0.05).Multivariate analysis found that NLR(HR =2.491,P =0.007),LDH(HR =1.922,P =0.031)and PNI(HR =0.358,P <0.001)were independent factors influencing the survival of patients with stage IIIB-IV non-small cell lung cancer.What's more,patients with three favorable factors had both better PFS and OS than those with two,one or no factors(P <0.001).Conclusions:The pretreatment NLR,LDH and PNI level were significantly correlated with the outcome of patients with advanced NSCLC patients after anti-PD-1 immunotherapy.The potential predictive value of these readily available biomarkers might help with risk stratification and treatment strategies.