The Clinical And Prognostic Value of NLR, PDW, And PNI In Advanced Non-Small-Cell Lung Cancer Treated With Platinum-Based Chemotherapy

Abstract Objective: The purpose of this study was to investigate the relationship between the neutrophil-lymphocyte ratio (NLR), platelet distribution width (PDW) and prognostic nutrient index (PNI), and the prognosis of patients with advanced non-small-cell lung cancer (NSCLC) treated with platinum-based chemotherapy.Methods: A total of 428 patients with advanced NSCLC treated with platinum-based chemotherapy between January 2015 and June 2019 were retrospectively analyzed. The patients were randomly divided into training set (n=300) and test set (n=128) in a ratio of 7:3, respectively. Clinical data and peripheral blood test results were collected within one week prior to the initiation of treatment to calculate PDW, NLR, and PNI. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values of PLR, PDW, and PNI. Kaplan-Meier method and Cox regression analysis were used to evaluate the prognostic factors of advanced NSCLC treated with platinum-based chemotherapy. A Nomogram model was established for predicting the prognosis in advanced NSCLC treated with platinum-based chemotherapy. The test set was used for external validation of the prognostic model.Results: There was no significant difference in the proportion of clinical features between the training set and the test set (P＞0.05). The ROC curve analysis determined the optimal cut-off values of PLR, PDW, and PNI to be 3.07, 16.81, and 52.025, respectively. Univariate and multivariate analyses indicated that tumor type (P=0.038), tumor differentiation (P=0.014), NLR (P=0.001), PDW (P<0.001), and PNI (P=0.009) were independent prognostic factors for PFS in patients with advanced NSCLC patients treated with platinum-based chemotherapy. Tumor type (P=0.002), tumor differentiation (P=0.038), EGFR status (P=0.002), NLR (P=0.010), PDW (P=0.001), and PNI (P=0.002) were independent prognostic factors for overall survival (OS) in advanced NSCLC patients treated with platinum-based chemotherapy. The established nomogram was validated internally and externally. The results showed a good agreement between the predicted value and the actual value of the calibration curve.Conclusion: NLR, PDW, PNI, tumor type, and tumor differentiation are independent prognostic factors for PFS in advanced NSCLC patients treated with platinum-based chemotherapy. NLR, PDW, PNI, tumor type, tumor differentiation, and EGFR status are independent prognostic factors for OS in advanced NSCLC patients treated with platinum-based chemotherapy. The established model has an application value in predicting the prognosis of advanced NSCLC patients treated with platinum-based chemotherapy.