Abstract
BACKGROUND: Neoadjuvant chemo-immunotherapy has increased the number of patients with advanced lung cancer eligible for surgery. However, only a small number of such patients respond to this approach. Intensive research is being conducted to identify biomarkers to predict the efficacy of neoadjuvant chemo-immunotherapy. Among these, blood predictive biomarkers are particularly promising, and have the advantages of being both non-invasive and cost effective. This study aims to evaluate the predictive value of blood biomarkers in determining the efficacy of neoadjuvant chemo-immunotherapy for patients with non-small cell lung cancer (NSCLC), addressing a critical need for more personalized treatment strategies in clinical practice. METHODS: We retrospectively collected the data of 199 NSCLC patients who received neoadjuvant chemo-immunotherapy from January 1, 2021 to December 31, 2023, at Zhejiang Cancer Hospital. We then analyzed the performance of blood biomarkers in predicting the efficacy of neoadjuvant chemo-immunotherapy. RESULTS: The patients in the major pathological response (MPR) group had significantly higher pre-treatment squamous cell carcinoma antigen (SCCA) levels, and a significantly lower post-treatment platelet-lymphocyte ratio (PLR) than those in the non-MPR group. For patients with higher pre-treatment SCCA levels, the 1- and 2-year event-free survival (EFS) rates were 97.87% [95% confidence interval (CI): 94.99-100.00%] and 93.21% (95% CI: 84.32-100.00%), respectively. In those with lower pre-treatment SCCA levels, the 1- and 2-year EFS rates were 91.39% (95% CI: 84.93-98.35%) and 82.24% (95% CI: 72.42-93.39%), respectively. The survival analysis showed that higher pre-treatment SCCA levels were correlated with improved EFS (P=0.02) in patients receiving neoadjuvant chemo-immunotherapy. Conversely, for patients undergoing surgery alone, high pre-treatment SCCA levels were correlated with a poorer prognosis [disease-free survival (DFS), P=0.001]. These findings confirm the value of SCCA levels in predicting which patients will have a more favorable response to neoadjuvant chemo-immunotherapy. In patients receiving neoadjuvant chemo-immunotherapy, a high post-treatment PLR indicated a poorer prognosis (P=0.02). The Cox regression analysis indicated that the pre-treatment SCCA level (P=0.04) and post-treatment PLR (P=0.04) were independent predictive factors of EFS. CONCLUSIONS: In patients receiving neoadjuvant chemo-immunotherapy, high pre-treatment SCCA levels and low post-treatment PLRs were significantly associated with better efficacy and survival. Thus, these biomarkers could be used to guide the choice of treatment modalities.