关键词: 癌, 非小细胞肺, 治疗, 预后, 系统免疫炎症指数, 中性粒细胞与淋巴细胞比值

Abstract:

Objective To explore the predictive value of neutrophil to lymphocyte ratio （NLR） and systemic immune-inflammation index （SII） of inflammatory markers of peripheral blood cells on the prognosis in the advanced non-small cell lung cancer （NSCLC） patients with immune therapy. Methods The hematologic and clinical data of 58 patients with advanced non-small cell lung cancer who received the treatment of immune therapy in the First People's Hospital of Chuzhou of Anhui Province from January 2018 to June 2022 were retrospectively analyzed. X-tile software was used to calculate the optimal cut-off values of NLR and SII. All patients were divided into high and low groups according to the optimal cut-off values. The relationship between different NLR，SII and clinicopathological features，clinical efficacy，prognosis of the advanced non-small cell lung cancer patients with immune therapy were analyzed. Cox regression models were used to perform univariate and multivariate analyses of factors affecting patient prognosis. Results The optimal cut-off values for NLR and SII were 3.2 and 546.5，respectively. There were statistically significant differences in regional lymph node metastasis （χ²=5.03，P=0.025） and the number of metastatic sites （χ²=11.60，P=0.001） between patients in the low-NLR group （NLR<3.2，n=26） and the high-NLR group （NLR≥3.2，n=32）. There were statistically significant differences in location of the primary site （χ²=8.34，P=0.004） between patients in the low-SII group （SII<546.5，n=28） and the high-SII group （SII≥546.5，n=30）. The objective response rate （ORR） of the low-NLR group [50.00%（13/26）] was higher than that of the high-NLR group [21.88%（7/32）]，and there was a statistically significant difference （χ²=5.02，P=0.025）； the disease control rate （DCR） of the low-NLR group [69.23%（18/26）] was higher than that of the high-NLR group [50.00%（16/32）]，but there was no statistically significant difference （χ²=2.19，P=0.139）. The ORR of the low-SII group [53.57%（15/28）] was higher than that of the high-SII group [26.67%（8/30）]； The DCR of the low-SII group [67.86%（19/28）] was higher than that of the high-SII group [33.33%（10/30）]，and there were statistically significant differences （χ²=4.38，P=0.036； χ²=6.91，P=0.009）. The median overall survival （OS） of patients in the low-NLR group （17.6 months） was longer than that of the high-NLR group （11.7 months），and there was a statistically significant difference （χ²=11.07，P=0.001）. The median OS of patients in the low-SII group （16.5 months） was longer than that of the high-SII group （12.3 months），and there was a statistically significant difference （χ²=5.53，P=0.019）. Univariate analysis showed that Eastern Cooperative Oncology Group （ECOG） score （HR=2.20，95%CI：1.10-4.39，P=0.025），brain metastases （HR=3.24，95%CI：1.61-6.50，P=0.001），the number of transferred sites （HR=2.83，95%CI：1.44-5.57，P=0.003），NLR （HR=3.22，95%CI：1.56-6.66，P=0.002） and SII （HR=2.18，95%CI：1.12-4.24，P=0.021） were all independent influence factors affecting the prognosis of the advanced non-small cell lung cancer patients with immune therapy； multivariate analysis showed that brain metastases （HR=2.91，95%CI：1.22-6.94，P=0.016），NLR （HR=2.88，95%CI：1.17-7.13，P=0.022） and SII （HR=3.63，95%CI：1.40-9.39，P=0.008） were all independent risk factors affecting the prognosis of the advanced non-small cell lung cancer patients with immune therapy. Conclusion NLR and SII can be used as important indicators for predicting the efficacy of immunotherapy in the advanced NSCLC and elevated NLR and SII can indicate poor prognosis of patients.

Key words: Carcinoma, non-small-cell lung, Therapy, Prognosis, Systemic immune-inflammation index, Neutrophil to lymphocyte ratio