The effect of immunonutritional support in patients undergoing surgery and adjuvant chemotherapy for lung cancer

This study investigated the association between early postoperative immunonutritional support and systemic inflammatory response in patients undergoing lung cancer resection followed by adjuvant chemotherapy.

We retrospectively analyzed 113 patients who underwent lung resection for lung cancer and received adjuvant CT between January 2023 and March 2025. Patients were classified according to whether they received immunonutritional support (NS). Patients in the NS group received an immunomodulating formula enriched with arginine, omega-3 fatty acids, and nucleotides, initiated within the first postoperative week. Chemotherapy was commenced in the first postoperative month, meaning that patients had already received one month of nutritional support prior to the initiation of chemotherapy. Biochemical measurements were taken one week before starting adjuvant chemotherapy and within one week after completion of the last chemotherapy cycle. Immunonutritional status was evaluated using the Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Pan-Immune Inflammation Index (SII), Pan-Immune Inflammation Value (PIV), C-reactive Protein-to-Albumin Ratio (CAR), and Lactate Dehydrogenase-to-Albumin Ratio (LAR), measured before CT, after CT, and through interval changes.

More patients in the NS group presented with advanced disease (stage III-IV) (p = 0.005), underwent thoracotomy (p = 0.024), and received more extensive resections (p < 0.001). No significant differences were observed between groups in pre-CT, post-CT, or interval changes for NLR, PLR, SII, or PIV. CAR and LAR values were significantly higher in the NS group before CT (p = 0.015 and p < 0.001, respectively). After CT, patients receiving NS exhibited significant reductions in both markers, whereas those without NS showed increases (p < 0.001). In multivariable models adjusted for disease stage, surgical approach, and resection extent, significant nutritional support × time interactions were observed for both CAR and LAR (p = 0.002), indicating differential temporal patterns between patients receiving and not receiving nutritional support.

Early postoperative immunonutritional support was associated with differential changes in selected immuno-inflammatory biomarkers, particularly CAR and LAR, during adjuvant chemotherapy. These findings suggest a potential association between nutritional support and modulation of inflammatory-metabolic responses; however, given the retrospective design and absence of direct clinical outcome data, the clinical implications require confirmation in prospective studies.