The Predictive Role Of Hematological Indicators In The Efficacy Of Immune Checkpoint Inhibitors In Patients With NSCLC

Objective:To evaluate the predictive role of hematological indicators in the efficacy of immunotherapy for non-small cell lung cancer,and to explore the correlation between hematological indicators and immune-related adverse events(ir AEs).Methods:A retrospective analysis of the clinical data of 130 lung cancer patients who were treated with immune checkpoint inhibitors at the Tumor Center of the First Hospital of Jilin University from January 2017 to December 2020.The efficacy was evaluated according to RECIST 1.1.Use Cox regression model to evaluate blood routine,lactate dehydrogenase(LDH),albumin,lymphocyte subsets,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte and monocyte Cell Ratio(LMR),Systemic Immune Inflammation Index(SII),Prognostic Nutrition Index(PNI),Advanced Lung Cancer Inflammation Index(ALI)for predicting efficacy,and exploring the above indicators and ir AEs risk factors Correlation between.Results:1.In all patients,lactate dehydrogenase≤200 IU/L(P<0.001)and SII≤1026(P<0.001)are independent prognostic factors of PFS with longer immune checkpoint inhibitors in non-small cell lung cancer;lactate dehydrogenase≤200 IU/L(P=0.035),ALI>378(P=0.024)are independent related factors for better ORR;albumin>39 g/L(P=0.016),LMR>2(P=0.028)is better independently related factors of DCR.2.In the adenocarcinoma subgroup,lactate dehydrogenase≤200 IU/L(P=0.004)and LMR>2(P=0.005)are independent prognostic factors for longer PFS;NLR>2.67(P=0.043)is better Independently correlated factors of ORR;SII≤1026(P=0.018)is an independent correlated factor of better DCR.3.In the squamous cell carcinoma subgroup,platelet≤240×10~9/L(P=0.012)is an independent prognostic factor for longer PFS;ALI>378 is better for ORR(P=0.010)and DCR(P=0.020)independently related factors.4.In the first-line immune monotherapy,the absolute value of monocytes≤0.37×10~9/L(P=0.020)is an independent prognostic factor for longer PFS.In the second and third-line treatments of immune monotherapy,lactate dehydrogenase≤200 IU/L(P=0.032),platelet distribution width>12.6%(P=0.012),SII≤1026(P=0.015)are the longer PFS independent prognostic factors;ALI>378(P=0.037)is an independent correlation factor for better ORR;PLR≤148(P=0.002)is an independent correlation factor for better DCR.5.In the first-line treatment of immunotherapy,platelet≤240×10~9/L is an independent prognostic factor for longer PFS;lactate dehydrogenase≤200 IU/L is a better ORR(P=0.040)and DCR(P=0.008)independent related factors.6.In all patients,patients with peripheral blood CD4/CD8>0.95(P=0.048)before treatment had a longer PFS.7.In the immune single-agent subgroup,patients with PNI>52.8(P=0.027)and LMR≤2(P=0.049)have a higher risk of ir AEs.Conclusions:1.Among all NSCLC patients receiving ICI treatment,patients with low lactate dehydrogenase,low SII,and high CD4/CD8 have a better prognosis.2.In patients with lung adenocarcinoma treated with ICI,low lactate dehydrogenase and high LMR are better prognostic factors;in patients with lung squamous cell carcinoma,low platelet count is a better prognostic factor.3.In first-line immune monotherapy,the absolute value of low monocytes is independent of longer PFS Prognostic factors:In the second and third-line treatments of immune monotherapy,low lactate dehydrogenase,high platelet distribution width,and low SII are independent prognostic factors for longer PFS.In the first-line treatment of immunotherapy,low platelets are an independent prognostic factor for longer PFS.4.In the immune single-agent subgroup,low LMR and high PNI are at higher risk of adverse immune events.