Prognostic Role of Inflammatory and Nutritional Indices in NSCLC Patients Treated with Immune Checkpoint Inhibitors: Retrospective, Multicenter, Turkish Oncology Group Study of Overall and Elderly Populations
<i>Background and Objectives:</i> Despite advances in immunotherapy, predicting survival outcomes in patients with non-small-cell lung cancer (NSCLC) remains challenging. Inflammatory and nutritional indices such as the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index...
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2025-06-01
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| author | Ozkan Alan Tugba Akın Telli Sinem Akbas Selver Isik Eyyüb Çavdar Kubilay Karaboyun Aysegül Merc Cetinkaya Ferhat Ekinci Atike Pınar Erdoğan Mahmut Büyükşimsek Muhammed Muhittin Er Melek Karakurt Eryilmaz Taliha Güçlü Kantar Gamze Gököz Doğu Teoman Sakalar Ertuğrul Bayram Ali Inal Fatma Akdağ Kahvecioğlu İlhan Hacibekiroğlu Fatih Selçukbiricik Ali Murat Tatli Perran Fulden Yumuk |
| author_facet | Ozkan Alan Tugba Akın Telli Sinem Akbas Selver Isik Eyyüb Çavdar Kubilay Karaboyun Aysegül Merc Cetinkaya Ferhat Ekinci Atike Pınar Erdoğan Mahmut Büyükşimsek Muhammed Muhittin Er Melek Karakurt Eryilmaz Taliha Güçlü Kantar Gamze Gököz Doğu Teoman Sakalar Ertuğrul Bayram Ali Inal Fatma Akdağ Kahvecioğlu İlhan Hacibekiroğlu Fatih Selçukbiricik Ali Murat Tatli Perran Fulden Yumuk |
| author_sort | Ozkan Alan |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Despite advances in immunotherapy, predicting survival outcomes in patients with non-small-cell lung cancer (NSCLC) remains challenging. Inflammatory and nutritional indices such as the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Inflammatory Burden Index (IBI) have emerged as promising prognostic markers associated with overall survival (OS) in NSCLC patients. <i>Materials and Methods:</i> We retrospectively analyzed a total of 196 NSCLC patients treated with second-line nivolumab across multiple centers in Turkey. Of these, 101 patients aged ≥ 65 years were included in the elderly subgroup analysis. PNI, GNRI (in patients aged ≥ 65), and inflammation-based indices were calculated using pre-treatment laboratory values. ROC analysis determined optimal cut-off values. The Kaplan–Meier method and Cox proportional hazards models were used for survival analysis. <i>Results:</i> Median overall survival (OS) was 12.9 months in the full cohort and 12.1 months in patients aged ≥ 65. In univariate analysis, ECOG performance status (0–1), lower NLR (<3.3), lower PLR (<196.8), higher PNI (≥45.2), and higher GNRI (≥98.0) were significantly associated with longer OS. However, in the multivariate analysis adjusted for ECOG PS, NLR, PLR, and GNRI, only PNI remained an independent prognostic factor for OS in both the overall cohort [HR: 0.49, 95% CI: 0.26–0.92; <i>p</i> = 0.02] and elderly patients [HR: 0.45, 95% CI: 0.24–0.84; <i>p</i> = 0.01]. PNI is an independent prognostic biomarker for OS in NSCLC patients treated with immune checkpoint inhibitors. <i>Conclusions:</i> These findings support incorporating simple, cost-effective nutritional indices into clinical decision-making, particularly in elderly patients with NSCLC. |
| format | Article |
| id | doaj-art-d4552084bfb04f42a2a2713bc7ed755d |
| institution | DOAJ |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-d4552084bfb04f42a2a2713bc7ed755d2025-08-20T02:47:07ZengMDPI AGMedicina1010-660X1648-91442025-06-01617116010.3390/medicina61071160Prognostic Role of Inflammatory and Nutritional Indices in NSCLC Patients Treated with Immune Checkpoint Inhibitors: Retrospective, Multicenter, Turkish Oncology Group Study of Overall and Elderly PopulationsOzkan Alan0Tugba Akın Telli1Sinem Akbas2Selver Isik3Eyyüb Çavdar4Kubilay Karaboyun5Aysegül Merc Cetinkaya6Ferhat Ekinci7Atike Pınar Erdoğan8Mahmut Büyükşimsek9Muhammed Muhittin Er10Melek Karakurt Eryilmaz11Taliha Güçlü Kantar12Gamze Gököz Doğu13Teoman Sakalar14Ertuğrul Bayram15Ali Inal16Fatma Akdağ Kahvecioğlu17İlhan Hacibekiroğlu18Fatih Selçukbiricik19Ali Murat Tatli20Perran Fulden Yumuk21Division of Medical Oncology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul 34098, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Demiroglu Bilim University, Istanbul 34394, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Koc University School of Medicine, Istanbul 34450, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul 34854, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Tekirdağ Namık Kemal University, Tekirdag 59030, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Tekirdağ Namık Kemal University, Tekirdag 59030, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Akdeniz University, Antalya 07058, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Celal Bayar University, Manisa 45300, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Celal Bayar University, Manisa 45300, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Adana City Hospital, Adana 01230, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Necmettin Erbakan University School of Medicine, Konya 42080, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Necmettin Erbakan University School of Medicine, Konya 42080, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Pamukkale University, Denizli 20160, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Pamukkale University, Denizli 20160, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaras 46050, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Cukurova University, Adana 01330, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Mersin City Hospital, Mersin 33330, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya 54290, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya 54290, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Koc University School of Medicine, Istanbul 34450, TürkiyeDivision of Medical Oncology, Memorial Antalya Hospital, Antalya 07025, TürkiyeDivision of Medical Oncology, Department of Internal Medicine, Koc University School of Medicine, Istanbul 34450, Türkiye<i>Background and Objectives:</i> Despite advances in immunotherapy, predicting survival outcomes in patients with non-small-cell lung cancer (NSCLC) remains challenging. Inflammatory and nutritional indices such as the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Inflammatory Burden Index (IBI) have emerged as promising prognostic markers associated with overall survival (OS) in NSCLC patients. <i>Materials and Methods:</i> We retrospectively analyzed a total of 196 NSCLC patients treated with second-line nivolumab across multiple centers in Turkey. Of these, 101 patients aged ≥ 65 years were included in the elderly subgroup analysis. PNI, GNRI (in patients aged ≥ 65), and inflammation-based indices were calculated using pre-treatment laboratory values. ROC analysis determined optimal cut-off values. The Kaplan–Meier method and Cox proportional hazards models were used for survival analysis. <i>Results:</i> Median overall survival (OS) was 12.9 months in the full cohort and 12.1 months in patients aged ≥ 65. In univariate analysis, ECOG performance status (0–1), lower NLR (<3.3), lower PLR (<196.8), higher PNI (≥45.2), and higher GNRI (≥98.0) were significantly associated with longer OS. However, in the multivariate analysis adjusted for ECOG PS, NLR, PLR, and GNRI, only PNI remained an independent prognostic factor for OS in both the overall cohort [HR: 0.49, 95% CI: 0.26–0.92; <i>p</i> = 0.02] and elderly patients [HR: 0.45, 95% CI: 0.24–0.84; <i>p</i> = 0.01]. PNI is an independent prognostic biomarker for OS in NSCLC patients treated with immune checkpoint inhibitors. <i>Conclusions:</i> These findings support incorporating simple, cost-effective nutritional indices into clinical decision-making, particularly in elderly patients with NSCLC.https://www.mdpi.com/1648-9144/61/7/1160non-small-cell lung cancer (NSCLC)prognostic nutritional index (PNI)geriatric nutritional risk index (GNRI)immune checkpoint inhibitorsnivolumabinflammation-based indices |
| spellingShingle | Ozkan Alan Tugba Akın Telli Sinem Akbas Selver Isik Eyyüb Çavdar Kubilay Karaboyun Aysegül Merc Cetinkaya Ferhat Ekinci Atike Pınar Erdoğan Mahmut Büyükşimsek Muhammed Muhittin Er Melek Karakurt Eryilmaz Taliha Güçlü Kantar Gamze Gököz Doğu Teoman Sakalar Ertuğrul Bayram Ali Inal Fatma Akdağ Kahvecioğlu İlhan Hacibekiroğlu Fatih Selçukbiricik Ali Murat Tatli Perran Fulden Yumuk Prognostic Role of Inflammatory and Nutritional Indices in NSCLC Patients Treated with Immune Checkpoint Inhibitors: Retrospective, Multicenter, Turkish Oncology Group Study of Overall and Elderly Populations Medicina non-small-cell lung cancer (NSCLC) prognostic nutritional index (PNI) geriatric nutritional risk index (GNRI) immune checkpoint inhibitors nivolumab inflammation-based indices |
| title | Prognostic Role of Inflammatory and Nutritional Indices in NSCLC Patients Treated with Immune Checkpoint Inhibitors: Retrospective, Multicenter, Turkish Oncology Group Study of Overall and Elderly Populations |
| title_full | Prognostic Role of Inflammatory and Nutritional Indices in NSCLC Patients Treated with Immune Checkpoint Inhibitors: Retrospective, Multicenter, Turkish Oncology Group Study of Overall and Elderly Populations |
| title_fullStr | Prognostic Role of Inflammatory and Nutritional Indices in NSCLC Patients Treated with Immune Checkpoint Inhibitors: Retrospective, Multicenter, Turkish Oncology Group Study of Overall and Elderly Populations |
| title_full_unstemmed | Prognostic Role of Inflammatory and Nutritional Indices in NSCLC Patients Treated with Immune Checkpoint Inhibitors: Retrospective, Multicenter, Turkish Oncology Group Study of Overall and Elderly Populations |
| title_short | Prognostic Role of Inflammatory and Nutritional Indices in NSCLC Patients Treated with Immune Checkpoint Inhibitors: Retrospective, Multicenter, Turkish Oncology Group Study of Overall and Elderly Populations |
| title_sort | prognostic role of inflammatory and nutritional indices in nsclc patients treated with immune checkpoint inhibitors retrospective multicenter turkish oncology group study of overall and elderly populations |
| topic | non-small-cell lung cancer (NSCLC) prognostic nutritional index (PNI) geriatric nutritional risk index (GNRI) immune checkpoint inhibitors nivolumab inflammation-based indices |
| url | https://www.mdpi.com/1648-9144/61/7/1160 |
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