2422 - Dynamic Change of Systemic Inflammatory Score in Predicting Survival of Patient with Unresectable Stage III Non-Small Cell Lung Cancer Treated by Definitive Chemoradiotherapy with or without Consolidate Immunotherapy: A Single-Arm, Retrospective Study
Presenter(s)
S. Luo, Y. Yuan, Y. Wang, Y. Yang, T. Zhang, L. Deng, W. Liu Jr, W. Wang, X. Wang, J. Lv, Z. Zhou, Q. Feng, Z. Xiao, N. Bi, and J. Wang; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Purpose/Objective(s): To explore the prognostic value of systemic inflammatory score (SIS) in patient with unresectable stage III non-small cell lung cancer (NSCLC) treated by definitive chemoradiotherapy (dCRT) with or without immune checkpoint inhibitors (ICIs) consolidation.
Materials/Methods: Between January 2014 and December 2021, treatment- naïve patients with pathologically confirmed unresectable stage III NSCLC treated in our center were retrospectively reviewed underwent dCRT or dCRT plus ICIs. Complete peripheral blood count was collected to get the SIS value at the time of admission, after definitive radiotherapy, 1 month and 3 months after radiotherapy when evaluation of efficacy was conducted, and when progression was founded, respectively. Prognostic value was determined by Kaplan-Meier survival analysis and the power was proven by area under the curve (AUC) value in ROC curve. The primary endpoints were overall survival (OS). Cox regression analysis was conducted to identify the synergetic effects of other variants on SIS. The prognostic value was further compared to neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and other known independent prognostic factors.
Results: A total of 229 patients undergone dCRT, and 183 patients received dCRT plus ICIs were identified. The optimal cut-point of baseline SIS in dCRT cohort was 590 × 109, and 530 × 109 in dCRT plus ICIs cohort. Univariate and multivariate analysis indicates that baseline SIS is an independent predictor for OS, progress-free survival (PFS), localregional-free survival (LRFS) and distant metastasis-free survival (DMFS) in dCRT patients, but not with DMFS in dCRT plus ICIs population. Time-series analysis of SIS prognostic values indicates that high SIS level at 1 month after definitive therapy in dCRT cohort (SIS > 970 × 109) predicts poor OS (hazard ratio, [HR], 2.512, P < 0.001), PFS (HR, 1.726, P = 0.004), DMFS (HR, 1.625, P = 0.037), and that at 3 months in dCRT plus ICIs cohort (SIS > 1570 × 109) predicts poor OS (HR, 5.107, P =0.003). In addition to T stage, AUC of SIS is higher than NLR, PLR, and other traditional clinicopathological predictors in both cohorts.
Conclusion: SIS is an independent, reliable, reproducible prognosis factor for OS of unresectable stage III NSCLC patients before and after dCRT with or without ICIs consolidation. Dynamic changes of SIS during follow-up showed variable predictive value for survival.