Prognostic Risk Factors Predicting Survival in Metastatic Non-Small Cell Lung Cancer Patients Treated with Nivolumab

ABSTRACT
Aim: Non-small cell lung cancer (NSCLC) is a commonly occurring and potentially fatal type of cancer. The aim of this study is to investigate the effects of clinical, laboratory, and systemic inflammatory response data on progression-free survival (PFS) and overall survival (OS) in metastatic NSCLC patients who were treated with nivolumab as a second-line treatment following platinum-based therapy.
Materials and Methods: The sample of this retrospective single-center study consisted of 84 adult patients with metastatic NSCLC receiving nivolumab as second-line treatment. Demographic data, cancer diagnosis-related characteristics and laboratory parameters of the patients just before nivolumab was started were recorded. The C-reactive protein/albumin ratio (CAR), aspartate aminotransferase/alanine aminotransferase (De Ritis) ratio, Glasgow prognostic score (GPS), neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) parameters were calculated for each patient.
Results: The mean age for all participants was 62.08 ± 8.43 years. The median PFS and OS were 6.4 and 13 months, respectively. In the univariate risk analysis for PFS, Eastern Cooperative Oncology Group Performance Status (ECOG PS) (p=0.05), and CAR (p=0.046) were identified as significant prognostic risk factors for PFS. However, the multivariate analysis did not confirm these two parameters as prognostic factors for PFS. In the multivariate analysis, ECOG PS (HR=0.45, 95% CI 0.22–0.94, p=0.035), bone metastasis (HR=0.38, 95% CI 0.19–0.78, p=0.008), and the De Ritis ratio (HR=0.47, 95% CI 0.23–0.96, p=0.037) remained independent prognostic risk factors of OS.
Conclusion: In this study, in patients with metastatic NSCLC receiving nivolumab as second-line treatment, poor ECOG performance status, bone metastasis, and a high De Ritis ratio were identified as independent prognostic factors associated with shorter overall survival OS. These factors may help in evaluating patients' prognosis in clinical practice.
Keywords: Lung cancer, nivolumab, prognostic factors, CAR, Deritis ratio