The Predictive Value of NLR, PLR, LMR, NPAR and D-Dimer on the Efficacy and Prognosis of First-Line Immunotherapy for Extensive-Stage Small Cell Lung Cancer.

Purpose: To investigate the predictive value of peripheral blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), neutrophil percentage-to-albumin-ratio (NPAR), and D-dimer in the efficacy and prognosis of immunotherapy for extensive-stage small cell lung cancer (ES-SCLC). Patients and Methods: A total of 70 ES-SCLC were included. The diagnostic performance of inflammatory indexes and D-dimer in predicting the efficacy and prognosis of immunotherapy was evaluated using receiver operating characteristic curve (ROC). Disease control rate (DCR) was used as the assessment indicator for immunotherapy efficacy, and progression free survival (PFS) > 6 months was used as the judgement indicator for better prognosis. Using Lasso regression and logistic multivariate analysis to predict the efficacy and prognosis of immunotherapy, and the optimal cut-off value was determined according to the area under the ROC curve. Kaplan-Meier survival analysis was applied to compare survival differences between groups. Results: At baseline, PLR can predict the efficacy of immunotherapy in ES-SCLC patients, but cannot predict their prognosis. After two cycles of immunotherapy, NLR can not only predict the efficacy and prognosis of immunotherapy, but also be identified as an independent predictor of long-term PFS in multivariate analysis (P<0.01). The long-term PFS rate of the low NLR2 group (<2.2) was significantly higher than that of the high NLR2 group (≥ 2.2) (P<0.001), with median PFS of 4.83 months vs 9.9 months, respectively, P<0.001. Conclusion: After two cycles of chemotherapy combined with immunotherapy, the efficacy and prognosis of NLR and ES-SCLC immunotherapy are closely related and can serve as effective and reliable predictive indicators.