Blood biomarkers to predict the efficacy of neoadjuvant chemo-immunotherapy in non-small cell lung cancer patients

Background: Neoadjuvant chemo-immunotherapy has increased the number of patients with advanced lung cancer eligible for surgery. However, only a small number of such patients respond to this approach. Intensive research is being conducted to identify biomarkers to predict the efficacy of neoadjuvant chemoimmunotherapy. Among these, blood predictive biomarkers are particularly promising, and have the advantages of being both non-invasive and cost effective. This study aims to evaluate the predictive value of blood biomarkers in determining the efficacy of neoadjuvant chemo-immunotherapy for patients with nonsmall cell lung cancer (NSCLC), addressing a critical need for more personalized treatment strategies in clinical practice. Methods: We retrospectively collected the data of 199 NSCLC patients who received neoadjuvant chemoimmunotherapy from January 1, 2021 to December 31, 2023, at Zhejiang Cancer Hospital. We then analyzed the performance of blood biomarkers in predicting the efficacy of neoadjuvant chemo-immunotherapy. Results: The patients in the major pathological response (MPR) group had significantly higher pre-treatment squamous cell carcinoma antigen (SCCA) levels, and a significantly lower post-treatment platelet-lymphocyte ratio (PLR) than those in the non-MPR group. For patients with higher pre-treatment SCCA levels, the 1- and 2-year event-free survival (EFS) rates were 97.87% [95% confidence interval (CI): 94.99-100.00%] and 93.21% (95% CI: 84.32-100.00%), respectively. In those with lower pretreatment SCCA levels, the 1- and 2-year EFS rates were 91.39% (95% CI: 84.93-98.35%) and 82.24% (95% CI: 72.42-93.39%), respectively. The survival analysis showed that higher pre-treatment SCCA levels were correlated with improved EFS (P=0.02) in patients receiving neoadjuvant chemo-immunotherapy. Conversely, for patients undergoing surgery alone, high pre-treatment SCCA levels were correlated with a in predicting which patients will have a more favorable response to neoadjuvant chemo-immunotherapy. In patients receiving neoadjuvant chemo-immunotherapy, a high post-treatment PLR indicated a poorer prognosis (P=0.02). The Cox regression analysis indicated that the pre-treatment SCCA level (P=0.04) and post-treatment PLR (P=0.04) were independent predictive factors of EFS. Conclusions: In patients receiving neoadjuvant chemo-immunotherapy, high pre-treatment SCCA levels and low post-treatment PLRs were significantly associated with better efficacy and survival. Thus, these biomarkers could be used to guide the choice of treatment modalities.