Abstract
OBJECTIVE: To investigate the prognostic value of clinical and inflammatory markers predicting response to nivolumab in patients with metastatic non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Clinical, demographic and laboratory data of stage 4 NSCLC patients who were treated between February 2021 and November 2024 were analyzed. Before nivolumab treatment, inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), prognostic nutritional index (PNI), hemoglobin-albumin-lymphocyte-platelet score (HALP), neutrophil-to-eosinophil ratio (NER) and C-reactive protein-to-albumin ratio (CAR) were calculated. Factors affecting overall survival (OS) were determined by Cox regression analysis, and ROC curve analysis was used to calculate the ideal cut-off. RESULTS: The study included 229 NSCLC patients and the median age of the patients was 63 years. The majority were male (84.3%) and had right lung localization (56.8%). Median overall survival was calculated as 21.2 months (95% CI: 17.4-25.0). In univariate cox-regression analysis, the presence of brain metastases (HR: 2.08; p=0.004), liver metastases (HR: 1.85; p=0.014) and adrenal metastases (HR: 1.64; p=0.045) negatively affected the treatment response. Inflammatory markers such as high NLR (HR: 2.04; p<0.001), high SII (HR: 1.96; p<0.001), high CAR (HR: 1.84; p=0.001), high PLR (HR: 1.60; p=0.009) and high SIRI (HR: 1.51; p=0.021), low PNI (HR: 0.48; p<0.001), low HALP (HR: 0.49; p<0.001) and low LMR (HR: 0.65; p=0.016) were associated with poor prognosis. In multivariate analysis, the presence of brain metastasis (HR: 2.84; p<0.001), adrenal metastasis (HR: 1.64; p=0.046) and low PNI (HR: 0.44; p<0.001) together predicted poor prognosis and formed a statistical model on treatment response. CONCLUSION: In patients with metastatic NSCLC, nivolumab treatment response is predicted by inflammatory markers and the presence of brain and adrenal metastases. It was concluded that low PNI among inflammatory markers is a strong prognostic indicator in this patient group.