Inflammatory biomarkers refine progression risk stratification in NSCLC patients with stable disease

Early risk stratification of non-small cell lung cancer (NSCLC) patients with stable disease (SD) at first restaging is particularly challenging. We explored the prognostic value of clinical and inflammatory markers in this population.

We analysed a real-world cohort of prospectively enrolled advanced NSCLC patients undergoing systemic intravenous anticancer treatment in a palliative intent at the Medical University of Vienna between 2019 and 2024. Inflammatory blood markers were measured at baseline and first restaging, with blinded radiologic assessment. Uni- and multivariable logistic regression models evaluated associations with durable clinical benefit (DCB).

Eighty NSCLC patients with SD at first restaging were included (median age 65 years, 50% female). Of those, 41 (51.3%) achieved DCB. Baseline characteristics were largely comparable. Patients with DCB had lower baseline neutrophil-to-lymphocyte and lymphocyte-to-leukocyte ratios. At first follow-up, CRP was lower and albumin higher in patients with DCB. In univariable analysis, lower follow-up albumin and higher LDH were associated with reduced odds of DCB. In multivariable models, PD-L1 positivity and follow-up albumin remained associated with DCB. The combined clinical-inflammatory model showed the highest apparent discriminative performance (AUC 0.766), compared to clinical-only (AUC 0.657) and inflammatory-only models (AUC 0.727), although the incremental improvement was modest.

In patients with advanced NSCLC and SD at first restaging, inflammatory biomarkers were associated with additional discriminative information beyond clinical characteristics alone. A combined clinical-inflammatory model showed numerically higher discriminative performance; however, the improvement was modest.