Clinical determinants and biomarkers for predicting chemotherapeutic response in advanced non-small cell lung cancer:...

To evaluate clinical determinants and predictive biomarkers for response to platinum-based doublet chemotherapy in patients with advanced non-small cell lung cancer (NSCLC).

This retrospective study included 200 advanced NSCLC patients (Jan 2021-Jun 2023) stratified into responders (n = 54) and non-responders (n = 146) according to RECIST version 1.1. Clinical characteristics, pre-chemotherapy inflammatory indexes [neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR)], tumor markers [carcinoembryonic antigen (CEA), cytokeratin 19 fragment antigen 21-1 (CYFRA21-1)], and nutritional indicators [albumin (ALB), hemoglobin (HGB)] were analyzed.

ECOG performance status ≥2, stage IV disease, ≥3 metastatic sites, and liver metastases were independent risk factors for poor response, whereas ≥4 chemotherapy cycles were protective. Non-responders had higher NLR, PLR, CEA, CYFRA21-1, and lower ALB and HGB (all p < 0.05). ROC analyses showed good predictive performance (AUC 0.688-0.816, p < 0.001). Responders had longer median progression-free survival (7.0 vs 4.0 months) and overall survival (15.0 vs 9.0 months, both p < 0.001).

ECOG score ≥2, stage IV disease, multiple metastases, and liver metastases negatively impact chemotherapeutic response, whereas treatment continuity is protective. Baseline NLR, PLR, CEA, CYFRA21-1, ALB, and HGB show predictive utility. A favorable chemotherapeutic response is associated with significantly enhanced survival.