Effective dose to immune cells combined with platelet-to-lymphocyte ratio predicts lymphopenia and prognosis in unresectable locally advanced non-small cell lung cancer

作者：Yang H, Ma J, Tian C, Bao S, Zhang J, Wang F, Xu Y, Yu J, Chen D · 发表于：Frontiers in immunology · 年份：2025 · DOI：10.3389/fimmu.2025.1657972 · 被引用次数：41 · 研究领域：Carcinoma, Non-Small-Cell Lung、Lymphopenia、Lung Neoplasms、Blood Platelets、Lymphocytes、Humans、Male、Female、Middle Aged、Aged、Prognosis、Lymphocyte Count

BACKGROUND: In the management of unresectable locally advanced non-small cell lung cancer (LA-NSCLC), the lack of reliable predictive biomarkers for grade ≥ 3 radiation-induced lymphopenia (RIL3+) and prognosis remains a major challenge. This study aims to investigate whether effective dose to immune cells (EDIC) combined with pre-radiotherapy (RT) peripheral blood inflammatory indicators (PBIIs), especially platelet-to-lymphocyte ratio (PLR), could better predict RIL3+ and prognosis in patients with unresectable LA-NSCLC in the immunotherapy era. METHODS: We enrolled 139 patients with unresectable LA-NSCLC who received chemoradiation and consolidation immunotherapy. Logistic regression was used to identify the predictors of RIL3+. Spearman correlation analyses were used to estimate the correlations between each indicator and absolute lymphocyte count (ALC) nadir. Receiver operating characteristic (ROC) curves were used to determine the predictive performance and optimal cut-off of each indicator. Patients were then divided into low- and high-risk groups based on the above cut-offs. Cox proportional hazards regression was used to determine prognostic factors for progression-free survival (PFS) and overall survival (OS). Survival outcomes were assessed using Kaplan-Meier methods. RESULTS: Logistic regression showed that both EDIC (P = 0.002) and PLR (P < 0.001) were significantly associated with RIL3+. ROC curves showed the highest predictive power of the PLR among the PBIIs...