Prognostic scoring systems in first-line chemotherapy combined with immunotherapy: Unique predictive value of MDACC+NLR in ES-SCLC.

Abstract

e20117 Background: This study aims to assess and validate the feasibility of seven prognostic scoring systems in predicting outcomes of first-line chemotherapy combined with immunotherapy for extensive-stage small cell lung cancer (ES-SCLC), thereby offering guidance for personalized treatment strategies. Methods: This single-center retrospective study analyzed data from 197 patients with ES-SCLC who were treated at the Fourth Hospital of Hebei Medical University. The data encompassed clinicopathological characteristics, baseline peripheral blood biomarkers, treatment modalities, prognostic outcomes, and efficacy indicators. This study evaluated the impact of clinicopathological characteristics and seven scoring systems—RHM, MDACC, MDACC+NLR, MDA-ICI, LIPI, GRIm, and SII—on the efficacy and prognosis of first-line chemotherapy combined with immunotherapy for ES-SCLC. Univariate and multivariate Cox regression analyses were performed to assess the predictive value of clinicopathological characteristics and the seven prognostic scoring systems for treatment efficacy and prognosis. Kaplan-Meier analysis was also used to calculate progression-free survival (PFS) and overall survival (OS) for risk stratification based on the seven scoring systems, further validating their feasibility in prognostic evaluation. Differences were considered statistically significant at P<0.05. Results: Multivariate Cox analysis further revealed that poorer performance status (ECOG ≥ 1), lung metastases, and liver metastases were independent prognostic factors for both PFS and OS in patients with ES-SCLC. An analysis of seven scoring systems—RHM, MDACC, MDACC+NLR, MDA-ICI, LIPI, GRIm, and SII—showed that the MDACC+NLR scoring system effectively distinguished risk groups. The low-risk group had a significantly longer median progression-free survival (mPFS) compared to the high-risk group (P = 0.02) and also exhibited a significantly longer median overall survival (mOS) (P = 0.02). In the MDACC scoring system, no statistically significant difference was observed in mPFS among the low-, intermediate-, and high-risk groups (P = 0.17). However, a significant difference was noted in mOS (P = 0.02). No statistically significant differences in mPFS or mOS were observed in the RHM, MDA-ICI, LIPI, GRIm, and SII scoring systems. The P-values for mPFS were 0.69, 0.15, 0.94, 0.89, and 0.86, respectively, while the P-values for mOS were 0.56, 0.16, 0.85, 0.87, and 0.69, indicating that these scoring systems lacked discriminatory power in predicting survival outcomes. Conclusions: In clinical practice, the MDACC+NLR scoring system demonstrates superior predictive accuracy for evaluating the efficacy and prognosis of first-line chemotherapy combined with immunotherapy in patients with ES-SCLC, highlighting its potential as a valuable prognostic tool.