Value of inflammatory markers in assessing the prognosis of immunotherapy for advanced esophageal squamous cell carcinoma
Objective:To assess the prognostic value of inflammatory markers and clinical features in pa-tients with advanced esophageal squamous cell carcinoma(ESCC)receiving immunotherapy and to de-velop a prognostic nomograph model.Methods:Clinical data on patients with advanced ESCC who received immunotherapy at Renmin Hospital of Wuhan University from December 2018 to October 2022 was retrospectively collected.ROC curve was used to determine the optimal cut-off value of in-flammatory markers,the Wilcoxon test was used to assess the relationship between optimal tumor effi-cacy and changes in inflammatory markers,the Kaplan-Meier method was used to draw survival curves,the COX regression model was used to screen independent risk factors affecting patients'prog-nosis,and the nomograph model was constructed on this basis.The reliability and accuracy of the no-mograph model were evaluated by the consistency index(C-index)and calibration curve.Results:The best cut-off values for neutrophil to lymphocyte ratio(NLR),neutrophil to lymphocyte ratio(PLR),and systemic immune inflammation index(SⅡ)were 4.0,251.61,and 849.23,respectively.In the partial response(PR)group,NLR(P=0.013)and SⅡ(P=0.022)tended to decrease in patients after two cycles of immunotherapy compared to baseline levels.Median PFS was 14.9 and 4.6 months in patients with low NLR and high NLR,respectively(P＜0.001),and median overall survival(OS)was not reached in patients with low NLR and 11.8 months in patients with high NLR(P＜0.001);median PFS was 11.7 and 5.8 months in patients with low PLR and high PLR,respectively(P=0.001),while median OS was 21.3 and 14.1 months,respectively(P=0.003).Median progres-sion-free survival(PFS)was 12.4 and 5.9 months for patients with low SⅡ and high SⅡ,respectively(P＜0.001),and the median OS was 21.3 and 12.9 months,respectively(P=0.001).Multivariate COX regression analysis showed that the treatment line and NLR were independent influencing fac-tors for PFS.However,the treatment line,liver metastasis,and NLR were independent influencing factors for OS(all P＜0.05),and the C-index of the nomograph model constructed based on the above factors was 0.768(95％CI:0.728-0.808),and the calibrated prediction curves and the ideal curve fit well.Conclusion:The decrease in NLR and SⅡ levels is related to the short-term efficacy of immuno-therapy;treatment line,liver metastasis,and NLR were independent prognostic factors for advanced ESCC patients receiving immunotherapy,and the nomograph model based on these factors had good predictive accuracy.
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