Predictive value of nutritional biomarkers for immune checkpoint inhibitor efficacy in patients with non-small cell lung cancer.

BACKGROUND

Although immune checkpoint inhibitors (ICIs) have revolutionized advanced non-small cell lung cancer (NSCLC) treatment, clinical benefits vary. This study evaluated the predictive value of baseline nutritional and hematological markers for ICI efficacy and survival.

METHODS

A retrospective cohort of 124 advanced NSCLC patients receiving ICIs was evaluated. Patients were stratified by median cut-offs: prognostic nutritional index (PNI: 45), albumin (ALB: 40.2 g/L), body mass index (BMI: 20.1 kg/m2), and hemoglobin (Hb: 114 g/L). Independent predictors of binary short-term efficacy outcomes (ORR and DCR) and time-to-event long-term survival outcomes (PFS and OS) were identified using multivariate logistic regression and Cox proportional hazards regression models.

RESULTS

High baseline PNI and ALB were significantly associated with superior objective response and disease control rates (DCR). Multivariate analyses confirmed PNI (OR = 1.377, p = 0.014) and ALB (OR = 1.840, p = 0.003) as independent protective factors for DCR, alongside independent associations with prolonged progression-free and overall survival (OS) (all p < 0.05). BMI lost independent predictive value after multivariate adjustment. The combined PNI + ALB model consistently outperformed single markers, achieving 12-, 24-, and 36-month OS area under the curve (AUC) values of 0.802, 0.819, and 0.807, respectively.

CONCLUSION

Baseline PNI and ALB are non-invasive, independent predictors of short-term response and long-term survival in advanced NSCLC patients undergoing immunotherapy. Combining these markers improves prognostic discrimination.