Readily Available Prognostic Biomarkers of Lung Cancer Treated With Immune Checkpoint Inhibitors in Northeast China

There is a pressing clinical need for readily accessible markers to predict the efficacy of immune checkpoint inhibitors (ICIs) in lung cancer treatment. In this study, we aimed to evaluate the prognostic value of common pre-treatment nutrition/inflammation-based indicators in lung cancer patients receiving programmed death-ligand 1/programmed death-1 inhibitors in Northeast China.

We retrospectively evaluated 226 patients with advanced lung cancer who received ICIs between January 2019 and February 2024. Three nutrition/inflammation-based indicators were included. Researchers collected baseline clinical data from patients including body mass index (BMI), C-reactive protein (CRP), albumin, and platelet, lymphocyte, and neutrophil counts. The chi-square test was used to compare differences in the objective response rate (ORR) and disease control rate (DCR) between the high and low value subgroups defined by the optimal cut-offs of advanced lung cancer inflammation index (ALI), lymphocyte-to-CRP ratio (LCR), and neutrophil-to-lymphocyte ratio (NLR). Survival curves were plotted using the Kaplan-Meier method. Independent factors associated with overall survival (OS) and progression-free survival (PFS) were analyzed using the Cox proportional hazards regression model. The predictive ability of different indicators was assessed by calculating the C-index.

The overall ORR and DCR were 35.5% and 62.2%, respectively. Patients with low ALI, low LCR, or high NLR demonstrated markedly inferior responses to ICI therapy. The median PFS and OS for the entire cohort were 7.4 and 14.5 months, respectively. Low ALI, low LCR, and high NLR were significantly associated with reduced PFS and OS. Multivariate analysis further confirmed that ALI, LCR, and NLR were independent prognostic factors for both OS (all P < 0.001) and PFS (all P < 0.001). Low ALI was associated with an increased risk of adverse outcomes in lung cancer (hazard ratio [HR] for PFS: 1.526, 95% confidence interval [CI] 1.352-1.943; HR for OS: 1.532, 95% CI 1.314-1.886). C-index analysis indicated that ALI demonstrated the best predictive ability for PFS (0.626 [95% CI, 0.604-0.642]) and OS (0.639 [95% CI, 0.618-0.651]).

ALI, LCR, and NLR are associated with treatment efficacy and prognosis in patients with advanced cancer treated with ICIs. ALI demonstrated a higher predictive ability than LCR and NLR.