Predictive value of nutritional biomarkers for immune checkpoint inhibitor efficacy in patients with non-small cell lung cancer.

BACKGROUND: Although immune checkpoint inhibitors (ICIs) have revolutionized advanced non-small cell lung cancer (NSCLC) treatment, clinical benefits vary. This study evaluated the predictive value of baseline nutritional and hematological markers for ICI efficacy and survival. METHODS: A retrospective cohort of 124 advanced NSCLC patients receiving ICIs was evaluated. Patients were stratified by median cut-offs: prognostic nutritional index (PNI: 45), albumin (ALB: 40.2 g/L), body mass index (BMI: 20.1 kg/m2), and hemoglobin (Hb: 114 g/L). Independent predictors of binary short-term efficacy outcomes (ORR and DCR) and time-to-event long-term survival outcomes (PFS and OS) were identified using multivariate logistic regression and Cox proportional hazards regression models. RESULTS: High baseline PNI and ALB were significantly associated with superior objective response and disease control rates (DCR). Multivariate analyses confirmed PNI (OR = 1.377, p = 0.014) and ALB (OR = 1.840, p = 0.003) as independent protective factors for DCR, alongside independent associations with prolonged progression-free and overall survival (OS) (all p < 0.05). BMI lost independent predictive value after multivariate adjustment. The combined PNI + ALB model consistently outperformed single markers, achieving 12-, 24-, and 36-month OS area under the curve (AUC) values of 0.802, 0.819, and 0.807, respectively. CONCLUSION: Baseline PNI and ALB are non-invasive, independent predictors of short-term response and long-term survival in advanced NSCLC patients undergoing immunotherapy. Combining these markers improves prognostic discrimination.