Prognostic Model of Baseline Medications plus Neutrophil-to-lymphocyte Ratio in Patients with Advanced Non-small-cell Lung Cancer Receiving Immune Checkpoint Inhibitor plus Platinum Doublet: A Multicenter Retrospective Study

• Published in: Journal of Cancer 2023-01, Vol.14 (5), p.676-688
• Main Authors: Nasu, Izumi, Kondo, Masahiro, Uozumi, Ryuji, Takada, Shinya, Nawata, Shuichi, Iihara, Hirotoshi, Okumura, Yohei, Takemoto, Masashi, Mino, Kozo, Sasaki, Tadanori, Hirose, Chiemi, Aomori, Tohru, Shimano, Rena, Maeno, Ken, Oizumi, Satoshi, Kusumoto, Sojiro, Ohno, Yasushi, Ikemura, Shinnosuke, Takai, Daiya, Hara, Azusa, Kawazoe, Hitoshi, Nakamura, Tomonori
• Format: Article
• Language: English
• Subjects: Antibiotics; Antigens; Cancer therapies; Hospitals; Lung cancer; Lymphocytes; Medical prognosis; Medical records; Neutrophils; Patients; Pharmacy; Research Paper; Steroids; University faculty
• ISSN: 1837-9664; 1837-9664
• DOI: 10.7150/jca.80517

Association between baseline medications plus neutrophil-to-lymphocyte ratio (NLR) and the effectiveness of immune checkpoint inhibitor (ICI) plus platinum doublet remains unknown, despite several reported prognostic models. We used real-world data to investigate whether baseline medications plus NLR predict survival outcomes in patients with advanced non-small-cell lung cancer (NSCLC) receiving ICI plus platinum doublet. This multicenter, retrospective, observational study conducted in Japan between December 2018 and March 2021 used real-world data of consecutive patients with advanced NSCLC who received ICI (pembrolizumab or atezolizumab) plus platinum doublet as first-line treatment. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The prognostic score for baseline medications plus NLR was weighted by regression β coefficients and used to categorize patients into good, intermediate, and poor prognoses groups. In addition, time-dependent receiver operating characteristic curve analyses and univariable and multivariable Cox proportional hazards models were constructed. Overall, 241 patients were included. Poor prognosis was significantly associated with worse PFS (hazard ratio [HR]: 1.78; 95% confidence interval [CI]: 1.08-2.94; = 0.025) and OS (HR: 3.59; 95% CI: 2.05-6.28; < 0.001) than good prognosis. Harrell's C-index for this prognostic model was 0.648. Baseline medication plus NLR could predict progressively worse survival outcomes in patients with advanced NSCLC receiving ICI plus platinum doublet and could be used as a prognostic index for poor outcomes.