Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Japan.
Department of Respiratory Medicine, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Japan.
Lung Cancer. 2019 Oct;136:45-51. doi: 10.1016/j.lungcan.2019.08.006. Epub 2019 Aug 14.
Immune checkpoint inhibitors (ICIs) have been established as a novel strategy for non-small cell lung cancer (NSCLC) therapy. However, a definitive biomarker that can predict response to ICI therapy remains unestablished. The prognostic nutritional index (PNI) is used to assess immune-nutritional conditions and is a prognostic factor in patients with various malignancies; however, its usefulness as a biomarker of response to ICI therapy and survival outcomes in NSCLC patients is unknown. Thus, we retrospectively analyzed the clinicopathological features of advanced-stage or recurrent NSCLC patients treated with ICI therapy to identify predictors of response to ICI therapy and investigate the effects of pretreatment PNI levels on survival after ICI therapy.
We selected 102 consecutive NSCLC patients who were treated with ICI therapy from November 2015 to February 2019. We measured their pretreatment PNI levels and performed univariate and multivariate Cox regression analyses of progression-free survival (PFS) or overall survival (OS) after ICI therapy.
Pretreatment PNI levels were significantly associated with response to ICI therapy (objective response rate:P = 0.0131; disease control rate: P = 0.0002), PFS (P = 0.0013), and OS (P = 0.0053). In univariate and multivariate analyses of the associations between PNI, C-reactive protein (CRP) or neutrophil-lymphocyte ratio (NLR) and PFS or OS, NLR and PNI, but not CRP, are independent prognostic factors for PFS (NLR: relative risk [RR]=1.655, 95% confidence interval [CI]: 1.012-2.743, P = 0.0449, PNI: RR=1.704, 95% CI: 1.039-2.828, P = 0.0346). Only PNI showed a trend towards being an independent prognostic factor for OS (RR=1.606, 95% CI: 0.952-2.745, P = 0.0761).
The pretreatment PNI has the potential to be a simple and novel predictive biomarker of ICI response in NSCLC patients and might help to identify patients who will obtain a survival benefit from ICI therapy.
免疫检查点抑制剂（ICI）已被确立为非小细胞肺癌（NSCLC）治疗的一种新策略。然而，能够预测ICI 治疗反应的明确生物标志物尚未建立。预后营养指数（PNI）用于评估免疫-营养状况，是各种恶性肿瘤的预后因素；然而，其作为 NSCLC 患者对 ICI 治疗反应和生存结果的生物标志物的有用性尚不清楚。因此，我们回顾性分析了接受 ICI 治疗的晚期或复发性 NSCLC 患者的临床病理特征，以确定对 ICI 治疗反应的预测因子，并研究治疗前 PNI 水平对 ICI 治疗后生存的影响。
我们从 2015 年 11 月至 2019 年 2 月选择了 102 例接受 ICI 治疗的连续 NSCLC 患者。我们测量了他们治疗前的 PNI 水平，并对 ICI 治疗后无进展生存期（PFS）或总生存期（OS）进行了单因素和多因素 Cox 回归分析。
治疗前 PNI 水平与 ICI 治疗反应（客观缓解率：P=0.0131；疾病控制率：P=0.0002）、PFS（P=0.0013）和 OS（P=0.0053）显著相关。在 PNI、C 反应蛋白（CRP）或中性粒细胞-淋巴细胞比值（NLR）与 PFS 或 OS 之间的单因素和多因素分析中，NLR 和 PNI，但不是 CRP，是 PFS 的独立预后因素（NLR：相对风险 [RR]=1.655，95%置信区间 [CI]：1.012-2.743，P=0.0449，PNI：RR=1.704，95%CI：1.039-2.828，P=0.0346）。只有 PNI 显示出成为 OS 的独立预后因素的趋势（RR=1.606，95%CI：0.952-2.745，P=0.0761）。
治疗前 PNI 有可能成为 NSCLC 患者对 ICI 反应的一种简单而新颖的预测生物标志物，并可能有助于识别从 ICI 治疗中获得生存获益的患者。
