C‐PLAN index as a prognostic factor for patients with previously untreated advanced non‐small cell lung cancer who received combination immunotherapy: A multicenter retrospective study

Abstract

Background Combination immunotherapy (immune checkpoint inhibitors and cytotoxic anticancer agents) is widely used as first‐line treatment for advanced non‐small cell lung cancer (NSCLC). However, the therapeutic effect of combination immunotherapy has not been fully investigated. C‐reactive protein, performance status, lactate dehydrogenase, albumin, and derived neutrophil‐to‐lymphocyte ratio (C‐PLAN) are useful biomarkers for predicting the prognosis of NSCLC; however, there are no reports examining the C‐PLAN index, which combines these five factors in a single prognostic factor. Methods We retrospectively collected data from 178 patients with previously untreated advanced NSCLC who received combination immunotherapy at multicenter institutions in Nagano Prefecture between December 2018 and April 2022. We investigated the utility of the C‐PLAN index as a prognostic factor using Cox regression analysis and correlated it with survival. Results The good and poor C‐PLAN index groups included 85 and 93 patients, respectively. The good C‐PLAN index group had a longer median progression‐free survival (PFS) (10.7 vs. 6.0 months; p = 0.022) and overall survival (OS) (25.3 vs. 16.5 months; p = 0.003) than the poor C‐PLAN index group. The C‐PLAN index was an independent favorable prognostic factor that correlated with PFS and OS in multivariate analysis. The good C‐PLAN index group had a higher proportion of never‐smokers (16.5 vs. 4.3%; p = 0.007) and stage III disease/postoperative recurrence (32.9 vs. 15.1%; p = 0.005) than the poor C‐PLAN index group. Conclusion The C‐PLAN index is a useful prognostic factor for patients with previously untreated advanced NSCLC undergoing combination immunotherapy.

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

“…Therefore, development and validation of novel, cost-effective and non-invasive biomarkers for ICI-treated lung cancer patients is an urgent task for clinicians. A recent multicenter study for the first time has integrated PS status, inflammatory and nutritional markers into a novel biomarker named as C-PLAN index, which was found to effectively stratify the outcome of NSCLC patients receiving immunochemotherapy ( 17 ). In this study, a single-center retrospective study including both NSCLC and SCLC patients was performed to further validate whether C-PLAN could act as a reliable prognostic biomarker for ICI-treated lung cancer patients.…”

“…The C-PLAN index was scored as described previously ( 17 ). In brief, the C-PLAN index was calculated as the sum score of CRP, LDH, ALB, dNLR and PS, which were respectively scored as follows: score 0 (CRP<1.0mg/dL or LDH<223U/L or ALB≥3.5g/dL or derived NLR<3.0 or PS ≤ 1); score 1(CRP≥1.0mg/dL or LDH≥223U/L or ALB<3.5g/dL or derived NLR≥3.0 or PS>1).…”

“…A recent multicenter retrospective study has developed a comprehensive scoring system that integrates CRP, LDH, ALB, dNLR and PS (named as C-PLAN index) to predict the prognosis of NSCLC patients receiving immunotherapy combined with other anti-cancer therapies ( 17 ). In this study, an independent cohort was utilized to further investigate the prognostic value of C-PLAN index in ICI-treated lung cancer patients.…”