Prognostic Value of a New Marker, IBI Score and NLR Change in Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors (Prognostic value of IBI score and NLR change in NSCLC)

Year 2025, Volume: 12 Issue: 2, 91 - 98, 28.08.2025

Melek Özdemir , Gamze Gokoz Dogu , Burcu Yapar Taşköylü , Atike Gökçen Demiray , Serkan Değirmencioğlu , Arzu Yaren , Burçin Çakan Demirel , Tolga Doğan , Taliha Güçlü Kantar , Semra Taş , Bedriye Açıkgöz Yıldız , Gamze Serin Özel , Ceren Mordağ Çiçek

https://doi.org/10.47572/muskutd.1603917

Abstract

This study aims to investigate the prognostic value of IBI score (inflammatory benchmark index) and NLR (neutrophil lymphocyte ratio) change during treatment for overall survival (OS) and progression-free survival (PFS) in nonsmall cell lung cancer (NSCLC) patients. A total of 155 NSCLC patients without driver mutations who were treated with immune checkpoint inhibitor (ICI) were included in the study. Laboratory and clinical parameters evaluated at the beginning and third month of ICI treatment were retrospectively recorded. The prognostic value of IBI score, NLR ratio and NLR change values were analysed using CRP, neutrophil, lymphocyte and platelet values. The median follow-up period was 26 months. Chemotherapy and ICI status of the patients were recorded. Regardless of the stage of immunotherapy, 34.8% of the patients (54 patients) did not progress after ICI. 101 patients (65.2%) progressed after ICI. The increase in mortality was significant when NLR≥10.25 (p<0.001) and NLR Change≥3.60 (p<0.001). Age (p=0.021), ECOG performance (p=0.043), stage at diagnosis (p=0.013), NLR change (p<0.001) and NLR (p<0.001) were significantly associated with mOS. Age (p=0.013), stage at diagnosis (p=0.004), IBI score (p=0.027), NLR change (p=0.001) and NLR (p=0.002) were prognostic for PFS. All these results suggest that ‘IBI score and NLR change’ can be used as prognostic markers for ICI treatment response in NSCLC patients.

Keywords

IBI Score , NLR Change , NSCLC

Ethical Statement

Permission was obtained from Pamukkale University Ethics Committee for the study (Number:E-60116787-020-476120; permission date:15.01.2024, decision no:E.476120).

Supporting Institution

yok

Project Number

4

Thanks

Sevgili eşim ve anneme çok teşekkür ediyorum.

İmmün Kontrol Noktası İnhibitörleri Alan Küçük Hücreli Dışı Akciğer Kanseri Hastalarında Yeni Bir Belirtecin, IBI Skorunun ve NLR Değişiminin Prognostik Değeri (IBI skor ve NLR değişiminin NSCLC’de prognostik değeri)

Abstract

Bu çalışma, IBI skoru (inflamatuar ben chmark index) ve tedavi sırasındaki NLR (nötrofil lenfosit oranı) değişiminin nonsmall cell lung cancer (NSCLC) hastalarında genel sağkalım (OS) ve progresyonsuz sağkalım (PFS) için prognostik değerini araştırmayı amaçlamaktadır. Driver mutasyonu olmayan ve tedavi basamaklarında immün kontrol noktası inhibitörü (ICI) uygulanan 155 NSCLC tanılı hasta çalışmaya alındı. ICI tedavi başlangıcında ve tedavinin üçüncü ayında değerlendirilen laboratuvar ve klinik parametreler retrospektif olarak kaydedildi. CRP, nötrofil, lenfosit ve trombosit değeri kullanılarak; IBI skor, NLR oranı ve NLR change değerlerinin prognostik değeri analiz edildi. Ortalama takip süresi 26.07 aydı. Hastaların kemoterapi ve ICI alma durumları kaydedildi. İmmünoterapiyi kaçıncı basamakta alırsa alsın, ICI sonrası hastaların 34.8%’inde (54 hasta) progresyon görülmedi. 101 hasta (65.2%) ise ICI sonrası progrese oldu. NLR≥10.25 (p<0.001) ve NLR Change≥3.60 (p<0.001) olduğunda mortalitedeki artış anlamlı bulundu. Yaş (p=0.021), ECOG performans (p=0.043), tanıdaki evre (p=0.013), NLR change (p<0.001) ve NLR (p<0.001) ile mOS arasındaki ilişki anlamlı bulundu. Yaş (p=0.013), tanıdaki evre (p=0.004), IBI skor (p=0.027), NLR change (p=0.001) ve NLR (p=0.002) PFS için prognostik olduğu bulundu. Tüm bu sonuçlar ‘IBI skor ve NLR change’’in NSCLC hastalarında ICI tedavi yanıtı için prognostik belirteç olarak kullanılabileceğini düşündürmektedir.

Keywords

IBI Skor , NLR Değişimi , NSCLC

Project Number

4

References

• Coley WB. The treatment of malignant tumors by repeated inoculations of erysipelas. With a report of ten original cases. Clin Orthop Relat Res. 1991;3:11.
• Zhang B, Fang WT, Zhong H. Introduction to the 9th edition of TNM classification for lung cancer. Zhonghua zhong liu za zhi. 2024;46:206-10.
• Carbone DP, Ciuleanu TE, Schenker M, et al. Four year clinical update and treatment switching-adjusted outcomes with first-line nivolumab plus ipilimumab with chemotherapy for metastatic non small cell lung cancer in the CheckMate 9LA randomized trial. J Immunother Cancer. 2024;12:008189.
• Shi H, Zhang W, Zhang L, et al. Comparison of different predictive biomarker testing assays for PD-1/PD-L1 checkpoint inhibitors response:a systematic review and network meta analysis. Front Immunol. 2023;14:1265202.
• Cui Q, Li W, Wang D, et al. Prognostic significance of blood based PD-L1 analysis in patients with non small cell lung cancer undergoing immune checkpoint inhibitor therapy:a systematic review and meta analysis. World J Surg Oncol. 2023;21:318.
• Li Y, Liang X, Li H, Chen X. Efficacy and safety of immune checkpoint inhibitors for advanced non small cell lung cancer with or without PD-L1 selection:a systematic review and network meta analysis. Chin Med J (engl). 2023;136:2156-65.
• Yao Y, Li B, Xu Y, et al. East Asian patients who received immunotherapy based therapy associated with improved survival benefit in advanced non small cell lung cancer:an updated meta analysis. Cancer Med, 2024;13:7080.
• Song R, Ni H, Huang J, et al. Prognostic Value of inflammation immunity nutrition score and ınflammatory burden ındex for hepatocellular carcinoma patients after hepatectomy. J Inflamm Res. 2022;15:6463-79.
• Tuntinarawat P, Tangmanomana R, Kittisiam T. Association between alteration of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, cancer antigen-125 and surgical outcomes in advanced stage ovarian cancer patient who received neoadjuvant chemotherapy. Gynecol Oncol Rep. 2024;52:101347.
• Zhang D, Zhuang D, Li T, et al. An analysis of neutrophil to lymphocyte ratios and monocyte to lymphocyte ratios with six month prognosis after cerebral contusions. Front Immunol. 2024;15:1336862.
• Prelaj A, Rebuzzi SE, Pizzutilo P, et al. A Prognostic Score Using Clinical and Blood Biomarkers in Advanced Nonsmall Cell Lung Cancer Treated With Immunotherapy. Clin Lung Cancer. 2020;21:365-77.
• Murata D, Azuma K, Matsuo N, et al. Survival and biomarkers for cachexia in non small cell lung cancer receiving immune checkpoint inhibitors. Cancer Med. 2023;12:19471-9.
• Mayne ST, Playdon MC, Rock CL. Diet, nutrition, and cancer:past, present and future. Nat rev Clin Oncol. 2016;13:504-15.
• Laviano A, Koverech A, Mari A. Cachexia:clinical features when inflammation drives malnutrition. Proc Nutr Soc. 2015;74:348-54.
• Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow Lancet. 2001;17:539-45.
• Dvorak HF. Tumors:wounds that do not heal. Similarities between tumor stroma generation and wound healing. N Engl J Med. 1986;315:1650-9.
• Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancer related inflammation and treatment effectiveness. Lancet Oncol. 2014;15:493–503.
• Huh JW, Lee JH, Kim HR. Prognostic significance of tumor infiltrating lymphocytes for patients with colorectal cancer. Arch Surg. 2012;147:366–72.
• Que H, Fu Q, Lan T, et al. Tumor associated neutrophils and neutrophil targeted cancer therapies. Biochim Biophys Acta Rev Cancer. 2022;1877:188762.
• Musaelyan AA, Moiseyenko FV, Emileva TE, et al. Clinical predictors of response to single agent immune checkpoint inhibitors in chemotherapy pretreated non small cell lung cancer. Mol Clin Oncol. 2024;20:32.
• Cedrés S, Torrejon D, Martínez A, et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non small cell lung cancer. Clin Transl Oncol. 2012;14:864-9.
• Mahiat C, Bihin B, Duplaquet F, et al. Systemic inflammation/nutritional status scores are prognostic but not predictive in metastatic nonsmall cell lung cancer treated with first line ımmune checkpoint ınhibitors. Int J Mol Sci. 2023;24:3618.
• Diem S, Schmid S, Krapf M, et al. Neutrophil-to-lymphocyte ratio (nlr) and platelet-to-lymphocyte ratio (plr) as prognostic markers in patients with nonsmall cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer. 2017;111:176-81.
• Suh KJ, Kim SH, Kim YJ, et al. Post-treatment neutrophil-to-lymphocyte ratio at week 6 is prognostic in patients with advanced nonsmall cell lung cancers treated with anti-PD-1 antibody. Cancer Immunol Immunother. 2018;67:459-70.
• Lim JU, Kang HS, Yeo CD, et al. Predictability of early changes in derived neutrophil-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with advanced nonsmall cell lung cancer treated with immune checkpoint inhibitors. J Thorac Dis. 2021;13:2824-32.
• Guo L, Li J, Wang J, et al. Prognostic role of dynamic changes in inflammatory indicators in patients with nonsmall cell lung cancer treated with immune checkpoint inhibitors-a retrospective cohort study. Transl Lung Cancer Res. 2024;13:1975-87.
• Putzu C, Serra R, Campus R, et al. Complete blood count-based biomarkers as predictors of clinical outcomes in advanced nonsmall cell lung cancer patients with PD-L1 < 50% treated with first line chemoimmunotherapy. Curr Oncol. 2024;31:4955-67.
• Zhang Y, Yan N, Feng Y, et al. Inflammatory markers predict efficacy of immunotherapy in advanced nonsmall cell lung cancer: a preliminary exploratory study. Discov Oncol. 2025;16:8.
• Zheng HL, Wang FH, Zhang LK, et al. Trajectories of neutrophil to lymphocyte ratios during neoadjuvant chemotherapy correlate with short and long term outcomes in gastric cancer:a group based trajectory analysis. BMC Cancer. 2024;24:226.