Prognostic value of immunotherapy in advanced non-small cell lung cancer based on baseline and dynamic changes in hemoglobin, albumin, and platelets

Abstract

Immune checkpoint inhibitors enhance the tumor-killing ability of T-cells in non-small cell lung cancer (NSCLC), thereby boosting overall survival (OS) and transforming treatment for advanced stages. However, challenges persist, including low response rates and the absence of effective markers for candidate selection. This study evaluated the impact of hemoglobin, albumin, and platelet (HALP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) on immunotherapy efficacy and survival in advanced NSCLC. Furthermore, the study aimed to develop a nomogram based on these parameters. Clinical and hematological data from patients diagnosed with NSCLC who received immunotherapy were analyzed. Efficacy was assessed using the immune Response Evaluation Criteria in Solid Tumors (iRECIST), and progression-free survival (PFS) and OS were analyzed. Prediction models were based on baseline and post-treatment HALP, NLR, and PLR. The 203 included patients had a median follow-up of 16 months, a median PFS (mPFS) of 7 months (6.0 – 8.0), while the median OS (mOS) was not available (24.0 – not available). The PLR before treatment (PLR0) was linked to a higher disease control rate (DCR) (odds ratio [OR] = 0.258), while initial immunotherapy and NLR after four cycles of treatment (NLR4C) significantly boosted the objective response rate (ORR). Cox regression showed that HALP before treatment (HALP0), HALP after four cycles of treatment (HALP4C), and NLR before treatment (NLR0) significantly influenced PFS. Additionally, HALP0, NLR0, and PLR after four cycles of treatment (PLR4C) were associated with OS. The C-indices for PFS and OS were 0.823 and 0.878, respectively, indicating good prediction accuracy. HALP, NLR, and PLR at various time points effectively predicted immunotherapy response in advanced NSCLC patients. Low HALP with high NLR and PLR indicated a poor prognosis. The findings can provide the basis for stratified randomized controlled trials (RCTs) in the future.