Abstract
OBJECTIVE: To evaluate the prognostic significance of immunoinflammatory indicators and tumor markers in patients with non-small cell lung cancer (NSCLC) undergoing first-line chemotherapy. METHODS: This retrospective study included 306 NSCLC patients treated with first-line chemotherapy between January 2022 and January 2023. Clinical data, including demographic information, clinicopathological features, immunoinflammatory markers, and tumor markers, were collected. Survival was analyzed using Kaplan-Meier curves and compared with the log-rank test. Cox proportional hazards models were used to identify factors associated with overall survival (OS). Logistic regression was applied to predict 2-year mortality risk, and model performance was evaluated using receiver operating characteristic curves, area under the curve (AUC), calibration plots, and decision curve analysis. RESULTS: By the end of follow-up, 183 patients had died (mortality rate: 59.80%). Univariate analysis showed that high neutrophil-to-lymphocyte ratio (NLR), high platelet-to-lymphocyte ratio (PLR), low lymphocyte-to-monocyte ratio (LMR), and elevated levels of CEA, CA125, and CYFRA 21-1 were significantly associated with worse prognosis (all P<0.001). Multivariate analysis identified high PLR (HR=1.94, P=0.041) and high CEA (HR=2.13, P=0.002) as independent risk factors, while high LMR (HR=0.52, P=0.043) was protective. A logistic model combining CEA, PLR, and LMR showed high predictive accuracy for 2-year mortality (AUC=0.926). CONCLUSION: Combined assessment of immunoinflammatory and tumor markers improves prognostic accuracy in NSCLC patients receiving first-line chemotherapy and may guide individualized treatment strategies.