Identification of C-PLAN index as a novel prognostic predictor for advanced lung cancer patients receiving immune checkpoint inhibitors

Jiaxin Wang; Huaijuan Guo; Jingjing Yang; Jingxian Mao; Ying Wang; Xuebing Yan; Hong Guo

doi:10.3389/fonc.2024.1339729

Identification of C-PLAN index as a novel prognostic predictor for advanced lung cancer patients receiving immune checkpoint inhibitors

Front Oncol. 2024 Feb 8:14:1339729. doi: 10.3389/fonc.2024.1339729. eCollection 2024.

Authors

Jiaxin Wang^#¹, Huaijuan Guo^#¹, Jingjing Yang^#¹, Jingxian Mao¹, Ying Wang¹, Xuebing Yan¹, Hong Guo²

Affiliations

¹ Department of Oncology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
² Department of Thoracic Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.

^# Contributed equally.

Abstract

Objective: Increasing studies have highlighted the potential utility of non-invasive prognostic biomarkers in advanced lung cancer patients receiving immune checkpoint inhibitor (ICI) based anti-cancer therapies. Here, a novel prognostic predictor named as C-PLAN integrating C-reactive protein (CRP), Performance status (PS), Lactate dehydrogenase (LDH), Albumin (ALB), and derived Neutrophil-to-lymphocyte ratio (dNLR) was identified and validated in a single-center retrospective cohort.

Methods: The clinical data of 192 ICI-treated lung cancer patients was retrospectively analyzed. The pretreatment levels of CRP, PS, LDH, ALB and dNLR were scored respectively and then their scores were added up to form C-PLAN index. The correlation of C-PLAN index with the progression-free survival (PFS) or overall survival (OS) was analyzed by a Kaplan-Meier model. The multivariate analysis was used to identify whether C-PLAN index was an independent prognostic predictor.

Results: A total of 88 and 104 patients were included in the low and high C-PLAN index group respectively. High C-PLAN index was significantly correlated with worse PFS and OS in ICI-treated lung cancer patients (both p<0.001). The multivariate analysis revealed high C-PLAN index was an independent unfavorable factor affecting PFS (hazard ratio (HR)=1.821; 95%confidence interval (CI)=1.291-2.568) and OS (HR=2.058, 95%CI=1.431-2.959). The high C-PLAN index group had a significantly lower disease control rate than the low C-PLAN index group (p=0.024), while no significant difference was found for objective response rate (p=0.172). The subgroup analysis based on clinical features (pathological type, therapy strategy, TNM stage and age) confirmed the prognostic value of C-PLAN index, except for patients receiving ICI monotherapy or with age ranging from 18 to 65 years old. Finally, a nomogram was constructed based on C-PLAN index, age, gender, TNM stage and smoking status, which could predict well the 1-, 2- and 3-year survival of ICI-treated lung cancer patients.

Conclusion: The C-PLAN index has great potential to be utilized as a non-invasive, inexpensive and reliable prognostic predictor for advanced lung cancer patients receiving ICI-based anti-cancer therapies.

Keywords: C-PLAN; biomarker; immune checkpoint inhibitor; lung cancer; prognosis.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was financially supported by the China National Natural Science Foundation (No. 81902422), Jiangsu Natural Science Foundation (No. BK20231245), Program of Jiangsu Commission of Health (No. M2020024), Clinical Translational Foundation of Yangzhou University (No. AHYZUZHXM 202104) and Jiangsu Graduate Practical Innovation Program (No. SJCX23_2027).