外周血炎症指标预测中晚期非小细胞肺癌免疫联合化疗疗效

Predictive value of peripheral inflammatory markers for immunochemotherapy efficacy in advanced NSCLC

摘要

目的 评估治疗前炎症指标中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、全身免疫炎症指数（SII）对中晚期非小细胞肺癌（NSCLC）患者一线免疫联合化疗近期疗效的预测效能。方法 本研究回顾性纳入2022年1月—2025年6月于衡水市人民医院接受一线免疫联合化疗的中晚期NSCLC患者65例。基于治疗前血常规结果计算NLR、PLR及SII。采用受试者工作特征（ROC）曲线分析各指标对客观缓解率（ORR）的预测价值,并确定最佳临界值进行分组比较。结果 基线NLR、PLR及SII预测ORR的曲线下面积（AUC）分别为0.769、0.675和0.731。依据最佳临界值分组后,各低值组（低NLR组、低PLR组、低SII组）的客观缓解率均显著高于相应的高值组,差异均有统计学意义（P<0.05）。比较而言,基线NLR在该队列中显示出相对最优的预测效能。结论 治疗前NLR、PLR及SII水平对中晚期NSCLC免疫联合化疗的近期疗效具有预测作用,其中NLR的判别能力最佳。这些指标临床获取便捷,可作为治疗前疗效预判的简易、经济辅助工具。

Abstract

Objective To evaluate the predictive value of peripheral blood inflammatory indices—the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)—for early treatment response in advanced non-small cell lung cancer (NSCLC) patients receiving first-line immune checkpoint inhibitor plus chemotherapy. Methods In this retrospective study, we analyzed 65 advanced NSCLC patients treated with first-line immunotherapy-chemotherapy combination at Hengshui People’s Hospital from January 2022 to June 2025. The NLR, PLR, and SII were calculated from pretreatment complete blood counts. Receiver operating characteristic (ROC) curve analysis was used to assess their ability to predict objective response rate (ORR), and optimal cut-off values were determined to stratify patients into high- and low-level groups for each index. Results The areas under the ROC curve (AUC) for predicting ORR were 0.769 for NLR, 0.675 for PLR, and 0.731 for SII. When grouped by these optimal cut-offs, the low-NLR, low-PLR, and low-SII groups all achieved a significantly higher ORR compared to their corresponding high-level groups (all P<0.05). Among the three indices, baseline NLR demonstrated the strongest predictive performance. Conclusion Pretreatment levels of NLR, PLR, and SII are predictive of short-term response to immunotherapy-chemotherapy in advanced NSCLC, with NLR showing the best discriminative capacity. These inexpensive, routine blood-based markers could serve as practical adjunct tools for pretreatment outcome assessment.

关键词

非小细胞肺癌 / 中性粒细胞/淋巴细胞比值 / 血小板/淋巴细胞比值 / 全身免疫炎症指数 / 预测分析

Key words

non-small cell lung cancer / neutrophil-to-lymphocyte ratio / platelet-to-lymphocyte ratio / systemic immune-inflammation index / predictive analysis

[1] Guo L, Li J, Wang J, et al.Prognostic role of dynamic changes in inflammatory indicators in patients with non-small cell lung cancer treated with immune checkpoint inhibitors-a retrospective cohort study[J]. Transl Lung Cancer Res, 2024, 13(8): 1975-1987.
[2] Schöne N, Kemper M, Menck K, et al.PD-L1 on large extracellular vesicles is a predictive biomarker for therapy response in tissue PD-L1-low and -negative patients with non-small cell lung cancer[J]. Extracell Vesicles, 2024, 13(3): 12418.
[3] Lin S, Wang Y, Cai X, et al.Redictive indicators of immune therapy efficacy in hepatocellular carcinoma based on neutrophil-to-lymphocyte ratio[J]. Immunopharmacol, 2024, 15(8): 111477.
[4] Rebuzzi S E, Prelaj A, Friedlaender A, et al.Prognostic scores including peripheral blood-derived inflammatory indices in patients with advanced non-small-cell lung cancer treated with immune checkpoint inhibitors[J]. Crit Rev Oncol Hematol, 2022, 17(9): 103806.
[5] Rubenich D S, Domagalski J L, Gentil G F S, et al. The immunomodulatory ballet of tumour-derived extracellular vesicles and neutrophils orchestrating the dynamic CD73/PD-L1 pathway in cancer[J]. Extracell Vesicles, 2024, 13(7): 12480.
[6] Du J, Huang Z.NLR stability predicts response to immune checkpoint inhibitors in advanced hepatocellular carcinoma[J]. Sci Rep, 2024, 14(1): 19583.
[7] Lang Y, Yang J, Cao W.Immune checkpoint blockers plus chemotherapy as the first-line treatment for advanced or metastatic squamous non-small-cell lung carcinoma: a network meta-analysis and economic evaluation[J]. Front Pharmacol, 2025, 16(1): 1669965.
[8] Li S, Xu C, Meng Y, et al.Efficacy and Safety of Neoadjuvant Immunotherapy plus Chemotherapy versus Neoadjuvant Chemotherapy in Non-Small Cell Lung Cancer Treatment: A Mixed Method Meta-Analysis Based on Global Randomized Controlled Trials[J]. MedComm (2020), 2025, 6(6): 70211.
[9] Huang L, Zhu H, Dai L, et al.Clinical, immune cell, and genetic features predicting survival and long-term response to first-line chemo-immunotherapy treatment for non-small cell lung cancer[J]. Cancer Immunol Immunother, 2025, 74(7): 219.
[10] Ye G, Wu G, Qi Y, et al.Non-invasive multimodal CT deep learning biomarker to predict pathological complete response of non-small cell lung cancer following neoadjuvant immunochemotherapy: a multicenter study[J]. Immunother Cancer, 2024, 12(9): 009348.
[11] Haragan A, Field J K, Davies M P A, et al. Heterogeneity of PD-L1 expression in non-small cell lung cancer: Implications for specimen sampling in predicting treatment response[J]. Lung Cancer, 2019, 13(4): 79-84.
[12] Putzu C, Serra R, Campus R, et al.Complete Blood Count-Based Biomarkers as Predictors of Clinical Outcomes in Advanced Non-Small Cell Lung Cancer Patients with PD-L1 < 50% Treated with First-Line Chemoimmunotherapy[J]. Curr Oncol, 2024, 31(9): 4955-4967.
[13] Tan S, Zheng Q, Zhang W, et al.Prognostic value of inflammatory markers NLR, PLR, and LMR in gastric cancer patients treated with immune checkpoint inhibitors: a meta-analysis and systematic review[J]. Front Immunol, 2024, 15: 1408700.
[14] Cristinziano L, Modestino L, Antonelli A, et al.Neutrophil extracellular traps in cancer[J]. Semin Cancer Biol, 2022, 79: 91-104.
[15] Awasthi D, Sarode A.Neutrophils at the Crossroads: Unraveling the Multifaceted Role in the Tumor Microenvironment[J]. Mol Sci, 2024, 25(5): 2929.
[16] Zhang Y, Huang C, Li S.Influence of treatment-related lymphopenia on the efficacy of immune checkpoint inhibitors in lung cancer: a meta-analysis[J]. Front Oncol, 2023, 13: 1287555.
[17] Russo A, Russano M, Franchina T, et al.Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Outcomes with Nivolumab in Pretreated Non-Small Cell Lung Cancer (NSCLC): A Large Retrospective Multicenter Study[J]. Adv Ther, 2020, 37(3): 1145.
[18] Park Y G, Kim H D, Hyung J, et al.Factors associated with the efficacy of first-line nivolumab plus chemotherapy in advanced gastric cancer patients with deficient mismatch repair[J]. Gastric Cancer, 2024, 27(4): 840-849.
[19] Nasu I, Kondo M, Uozumi R, et al.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[J]. Cancer, 2023, 14(5): 676-688.
[20] Pan Y, Shi L, Liu Y, et al.Multi-omics models for predicting prognosis in non-small cell lung cancer patients following chemotherapy and radiotherapy: A multi-center study[J]. Radiother Oncol, 2025, 204: 110715.