Knetki-Wróblewska Magdalena, Grzywna Aleksandra, Krawczyk Paweł, Wojas-Krawczyk Kamila, Chmielewska Izabela, Jankowski Tomasz, Milanowski Janusz, Krzakowski Maciej
Department of Lung Cancer and Chest Tumours, The Maria Sklodowska-Curie National Research Institute of Oncology - National Research Institute, Warsaw, Poland.
Department of Pneumonology, Oncology, and Allergology, Medical University of Lublin, Lublin, Poland.
Transl Lung Cancer Res. 2025 Mar 31;14(3):749-760. doi: 10.21037/tlcr-24-675. Epub 2025 Mar 18.
Immune checkpoint inhibitors remain a therapeutic option for chemotherapy pretreated patients with advanced non-small cell lung cancer (NSCLC). Given the lack of biomarkers, there is a need to look for predictive factors in this population. Inflammatory markers derived from peripheral blood cells (PBCs) may be a valuable diagnostic tool to assess the likelihood of clinical benefit. The aim of the study was to evaluate the efficacy of the treatment and to analyse the NLR and PLR predictive values.
Patients eligible for nivolumab or atezolizumab treatment in routine practice in two cancer centres between 2018 and 2021 were retrospectively analysed. Good performance status (ECOG 0-1), absence of alterations and no previous immune checkpoint inhibitors treatment were the inclusion criteria. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated based on the results obtained before the start of immunotherapy. The median value was used as the cut-off point for comparative analyses.
The group of 332 patients was enrolled, 73.5% patients were in stage IV. The median NLR in the study group was 3.86±4.9 and the median PLR was 193.24±172.87. In the entire study group the disease control rate was 59 %, median PFS was 3.3 months [95% confidence interval (CI): 3.77 to 4.4], while median OS 11.57 months (95% CI: 9.03 to 12.73). In a univariate analysis the baseline values of NLR and PLR had a significant impact on survival, while age, gender, programmed death ligand 1 (PD-L1) expression, or type of treatment were not significant. In the multivariate Cox logistic regression model, a high value of NLR was the only factor that increased the risk of death [hazard ratio (HR) =1.6315, 95% CI: 1.2836 to 2.0737, P<0.001].
Inflammatory indices derived from peripheral blood cells-NLR and PLR-can help assess the prognosis of patients receiving immunotherapy. They also appear to be independent prognostic factors with regard to for PFS and OS.
免疫检查点抑制剂仍然是晚期非小细胞肺癌（NSCLC）化疗预处理患者的一种治疗选择。鉴于缺乏生物标志物，有必要在该人群中寻找预测因素。源自外周血细胞（PBC）的炎症标志物可能是评估临床获益可能性的一种有价值的诊断工具。本研究的目的是评估治疗效果并分析中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）的预测价值。
回顾性分析2018年至2021年期间在两个癌症中心接受纳武利尤单抗或阿替利珠单抗常规治疗的符合条件的患者。纳入标准为良好的体能状态（东部肿瘤协作组0 - 1）、无改变且既往未接受过免疫检查点抑制剂治疗。根据免疫治疗开始前获得的结果计算中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）。中位数用作比较分析的切点。
共纳入332例患者，73.5%的患者处于IV期。研究组的NLR中位数为3.86±4.9，PLR中位数为193.24±172.87。在整个研究组中，疾病控制率为59%，无进展生存期（PFS）中位数为3.3个月[95%置信区间（CI）：3.77至4.4]，而总生存期（OS）中位数为11.57个月（95% CI：9.03至12.73）。在单因素分析中，NLR和PLR的基线值对生存有显著影响，而年龄、性别、程序性死亡配体1（PD - L1）表达或治疗类型则无显著影响。在多因素Cox逻辑回归模型中，NLR的高值是增加死亡风险的唯一因素[风险比（HR）=1.6315，95% CI：1.2836至2.0737，P<0.001]。
源自外周血细胞的炎症指标——NLR和PLR——有助于评估接受免疫治疗患者的预后。它们似乎也是关于PFS和OS的独立预后因素。
