Prognostic Role Of Peripheral Blood Inflammatory Markers In Patients With Advanced NSCLC Treated With Third-generation EGFR-TKIs

Research background and purpose:Lung cancer is one of the most malignant tumors with the highest morbidity and mortality.Non-small cell lung cancer(NSCLC)is the most common pathological type of lung cancer.EGFR-TKIs targeted therapy significantly improves prognosis in patients with EGFR mutation,but there is a lack of effective prognostic indicators.In recent years,the prognostic effect of peripheral blood inflammatory indicators in advanced NSCLC patients with the first or second generations of EGFR-TKIs targeted therapy has been reported,but the prognostic effect in the third generation of EGFR-TKIs targeted therapy remains unclear.The objective was to explore the prognostic effect of pre-treatment inflammatory markers in peripheral blood in patients treated with third-generation EGFRTKIs.Inflammatory markers included:neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR),systemic immuneinflammation index,(SII)and pan-immune inflammation value(PIV).This study will explore the optimal cut-off values for five inflammatory markers and explore their association with progression free survival(PFS)in patients with targeted therapy.Materials and Methods:The clinical data of 142 patients with advanced NSCLC who received first-line treatment with third-generation EGFR-TKIs at Sichuan Cancer Hospital between January1,2019 and December 31,2021 were retrospectively analyzed.The optimal critical values of NLR,PLR,LMR,SII and PIV were determined by receiver operating characteristic curve(ROC)and maximum Yoden index,and the five inflammatory markers were divided into high and low groups according to the optimal critical values.Kaplan-Meier method was used to draw the survival curve and log-rank test was used to determined their differences.Univariate Cox regression analysis and multivariate Cox regression analysis were used to analyze the related influencing factors of progression-free survival(PFS).P < 0.05 indicated statistically significant differences.Result:1.According to the ROC curve and the maximum value of the Yoden index,the critical value of NLR is 2.87,PLR is 123.1,LMR is 4.56,SII is 569.1 and PIV is 153.2.2.Cox univariate analysis showed that clinical stage,type of gene mutation,radiotherapy,number of metastatic organs,NLR,LMR,SII and PIV had an impact on the prognosis in advanced NSCLC patients treated with third generation of EGFR-TKIs(P <0.05).3.Cox multivariate analysis showed that the number of transplanted organs(HR=2.97,P=0.01),NLR(HR=2.29,P=0.01),LMR(HR=0.381,P=0.02),SII(HR=2.06,P=0.021)and PIV(HR=2.06,P=0.021)were the independent prognostic factors for PFS in patients with advanced NSCLC.Conclusion:Number of metastatic organs,NLR,LMR,SII,and PIV were independent prognostic factors for PFS in patients with advanced NSCLC treated with first-line targeting of thirdgeneration EGFR-TKIs.The number of metastatic organs,and the level of baseline NLR,LMR,SII and PIV have predictive value for the prognosis of the patients.