Evaluation of Inflammatory Parameters and Ferritin as Prognostic Factors in Non-Small Cell Lung Cancer Patients Receiving Nivolumab Immunotherapy: Prognostic Inflammatory Biomarkers in NSCLC Immunotherapy

Abstract

Aim: Inflammation and immune dysfunction significantly impact cancer progression and treatment responses. This retrospective study investigated inflammatory parameters and ferritin in predicting immunotherapy response in non-small cell lung cancer (NSCLC) patients. Methods: The study included 199 patients with NSCLC who received nivolumab between 2018 and 2024 at five medical centers. Various inflammatory markers were also evaluated. Ferritin levels at diagnosis and pretreatment were also evaluated. Results: ROC curve analyses showed ferritin delta had high prognostic performance for PFS and OS, with AUC values of 0.70 and 0.73. PIV and PNI were significantly associated with PFS and OS. In Kaplan-Meier analyses, PNI was the most consistent prognostic factor. Low PNI (<= 43.5) significantly associated with shorter OS (5.0 vs. 15.0 months, p = 0.001) and shorter PFS (4.0 vs. 8.0 months, p = 0.002). High mGPS (score 2) and elevated PIV showed significant prognostic value. In multivariate Cox regression, PNI demonstrated independent prognostic significance. Objective response rate was the strongest prognostic factor for PFS (HR = 0.188, 95%CI: 0.114-0.309, p < 0.001). Conclusion: These findings highlight the prognostic value of inflammatory and nutritional markers in patients with NSCLC receiving immunotherapy. PNI demonstrated the most consistent prognostic value across multiple analytical approaches and maintained significance in the multivariate analysis.