NLCIPS: Non-Small Cell Lung Cancer Immunotherapy Prognosis Score.

introductionCurrently in China, many immune checkpoint inhibitors (ICIs) have been approved for the treatment of non-small cell lung cancer (NSCLC). Some patients can not benefit from ICIs, and approximately 50% of patients have immunotherapy-related toxicity. Therefore, it is necessary to monitor carefully the selection of immunotherapy population using biomarkers to maximize the benefit of patients with NSCLC.

methodsA prospective analysis was performed on patients with advanced NSCLC who were treated with ICIS at our hospital from March 2018 to June 2019, up to the follow-up deadline of December 31, 2019. The primary end points were overall survival (OS) and progression-free survival (PFS), and the secondary end points were objective response rate and disease control rate. A lasso regression was used for the univariate analysis, and Cox regression analysis was used for the multivariate analysis. An efficacy prediction line chart was developed.

resultsA total of 63 patients were included in the study. The median PFS was 7.0 months (95% CI, 5.0-11.0) and did not reach the median OS. According to the lasso regression, significant univariate factors were smoking index, PD-ligand 1 expression, and neutrophil to lymphocyte ratio (NLR). According to the multivariate analysis, the Cox proportional hazards model showed that smoking index and NLR are independent predictors of PFS in immunotherapy. A model comprised of independent predictors was developed based on a multivariate logical analysis of the main cohort-non-small cell lung cancer immunotherapy prognosis score. This model is shown as a nomogram with a C-index of 0.801 (95% CI, 0.744, 0.858), which has high prediction accuracy.

conclusionThis predictive model, including NLR and smoking index, can achieve a 1-year PFS in immunotherapy of patients. PD-1 inhibitors have been demonstrated to be effective and safe in the clinical treatment of patients with NSCLC.