Prognostic impact of sarcopenia and blood biomarkers in advanced non-small cell lung cancer on first-line immune checkpoint inhibitors.

Although immune checkpoint inhibitors (ICIs) have improved outcomes in advanced non-small cell lung cancer (NSCLC), the prognostic tools for programmed death-ligand 1 (PD-L1), the only approved biomarker, remain limited. We comprehensively evaluated the prognostic impact of sarcopenia and various blood biomarkers in 74 NSCLC patients receiving first-line ICIs. Sarcopenia was diagnosed using dual-energy X-ray absorptiometry. Cytokines and myokines in peripheral blood samples were assessed using Enzyme-linked immunosorbent assay (ELISA) and cytometric bead array, while lymphocyte subsets were characterized using flow cytometry. Sarcopenia group had significantly shorter progression-free survival (PFS) (P = 0.018). Sarcopenia was revealed as an independent poor prognostic factor for PFS (HR 2.63, 95% CI 1.19−5.8; P = 0.017). Patients with sarcopenia showed elevated levels of inflammatory cytokines (interleukin (IL)-6, IL-8, IL-10, IL-15, and tumor necrosis factor). Furthermore, sarcopenia index and muscle mass were negatively correlated with exhausted CD8 + T cells (CD8 + TIGIT+). The sarcopenia with high TIGIT expression group exhibited the worst prognosis (HR 3.5, P = 0.0087). Sarcopenia, immune-related blood biomarkers and high TIGIT expression were identified as independent poor prognostic factors in advanced NSCLC patients receiving first-line ICI therapy.