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. 2023 Jul 31;12(7):1506-1516.
doi: 10.21037/tlcr-23-7. Epub 2023 Jul 14.

Prognostic value of baseline and early treatment response of neutrophil-lymphocyte ratio, C-reactive protein, and lactate dehydrogenase in non-small cell lung cancer patients undergoing immunotherapy

MinDong Sung #  1 , Won Seok Jang #  2 , Hae Reong Kim  2 , Ji Ae Park  2 , Sun Min Lim  3 , Hye Ryun Kim  3 , Byoung Chul Cho  3 , Yu Rang Park  2 , Min Hee Hong  3
Affiliations

Prognostic value of baseline and early treatment response of neutrophil-lymphocyte ratio, C-reactive protein, and lactate dehydrogenase in non-small cell lung cancer patients undergoing immunotherapy

MinDong Sung et al. Transl Lung Cancer Res. .

Abstract

Background: Not all non-small cell lung cancer (NSCLC) patients will benefit from immune checkpoint therapy and use of these medications carry serious autoimmune adverse effects. Therefore, biomarkers are needed to better identify patients who will benefit from its use. Here, the correlation of overall survival (OS) with baseline and early treatment period serum biomarker responses was evaluated in patients with NSCLC undergoing immunotherapy.

Methods: Patients diagnosed with NSCLC undergoing immunotherapy (n=597) at a tertiary academic medical center in South Korea were identified between January 2010 and November 2021. The neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), and lactate dehydrogenase (LDH) levels in the survival and non-survival groups were examined at baseline and early treatment periods. Additionally, aberrant laboratory parameters at each period were used to stratify survival curves and examine their correlation with one-year OS.

Results: In the non-survival group, the NLR, CRP, and LDH levels at the early treatment period were higher than those at the baseline (P<0.001). The survival curves stratified based on aberrant laboratory findings in each period varied (log-rank test P<0.001). Multivariate Cox regression analysis revealed that having prescribed more than 3rd line of chemotherapy [hazard ratio (HR) =3.19, 95% confidence interval (CI): 1.04-9.82; P=0.043] and early treatment period CRP (HR =3.88; 95% CI: 1.55-9.72; P=0.004) and LDH (HR =4.04; 95% CI: 2.01-8.12; P<0.001) levels were significant predictors of one-year OS.

Conclusions: Early treatment period CRP and LDH levels were significant predictors of OS in patients with NSCLC undergoing immunotherapy.

Keywords: C-reactive protein (CRP); Non-small cell lung cancer (NSCLC); immunotherapy; lactate dehydrogenase (LDH); neutrophil-lymphocyte ratio (NLR).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-23-7/coif). MS received funding from MD-PhD/Medical Scientist Training Program (the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea). The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
A flow diagram of study participant selection criteria for the study. NSCLC, non-small cell lung cancer.
Figure 2
Figure 2
Kaplan-Meier curves for OS stratified based on aberrant laboratory parameters at baseline and early treatment period in patients with non-small cell lung cancer undergoing immunotherapy only. Strata 1, 2, 3, and 4 indicate baseline physiological and early treatment period physiological, baseline physiological and early treatment period aberrant, baseline aberrant and early treatment period physiological, and baseline aberrant laboratory parameter and early treatment period aberrant laboratory parameter respectively. (A) Kaplan-Meier curves of OS stratified based on aberrant NLR at baseline and early treatment period; (B) Kaplan-Meier curves of OS stratified based on aberrant CRP at baseline and early treatment period; (C) Kaplan-Meier curves of OS stratified based on aberrant LDH at baseline and early treatment period. NLR, neutrophil-lymphocyte ratio; CRP, C-reactive protein, LDH, lactate dehydrogenase; OS, overall survival.
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