Nutritional inflammatory hematological risk index predicts clinical outcomes in patients with advanced NSCLC receiving immunotherapy.

Abstract

In real-world clinical settings, patients with advanced non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs) display significant heterogeneity, highlighting the need to identify key prognostic biomarkers and clinical factors. This retrospective study included 340 advanced NSCLC patients treated with ICIs. Cox regression analyses identified factors associated with progression-free survival (PFS). A Nutritional Inflammatory Hematological Risk Index (NIHRI) was constructed using these factors, and a prognostic nomogram was developed. Performance was assessed using the C-index, calibration plots, and decision curve analysis (DCA), with internal validation via bootstrapping. Hemoglobin and the albumin-to-alkaline phosphatase ratio (AAPR) were independent prognostic factors. The NIHRI, combining dichotomized hemoglobin (< 120 g/L vs. ≥120 g/L) and AAPR (< 0.56 vs. ≥0.56), stratified patients into low- (0 points), intermediate- (1 point), and high-risk (2 points) groups, with significantly different PFS (P<0.001). The nomogram, incorporating NIHRI, tumor stage, PD-L1, and ECOG-PS, demonstrated a C-index of 0.70 (optimism-corrected: 0.69) and predictive accuracy for 1-, 2-, and 3-year PFS (AUCs: 0.81, 0.85, and 0.88, respectively). DCA confirmed its acceptable clinical net benefit. We developed and validated a novel prognostic tool, the NIHRI, based on a combination of hemoglobin and AAPR. This integrated nomogram provides a non-invasive and clinically accessible quantitative method for predicting prognosis in patients with NSCLC undergoing immunotherapy, thereby aiding in personalized clinical decision-making.