接受一线免疫疗法治疗的程序性细胞死亡配体 1 (PD-L1) ≥50% 的转移性非小细胞肺癌 (NSCLC) 患者表现出异质性肿瘤反应。在这项研究中，我们研究了临床和免疫炎症标志物，以区分获得高肿瘤反应深度（HDPR）的转移性非小细胞肺癌患者与非高反应深度（NHDPR）患者。进一步明确临床特征对PD-L1≥50%患者预后的影响。2020年7月至12月北京天坛医院收治的17例PD-L1≥50%转移性NSCLC患者的临床特征及免疫炎症标志物回顾性分析2023年的情况。在17名患者中，7名（41.2%）患者实现HDPR（范围：-50%，-72%），10名（58.8%）患者实现NHDPR（范围：-13%，-45%）。与 HDPR 相比，NHDPR 的 CD4  T 淋巴细胞/CD8 T 淋巴细胞 (CD4/CD8) 比率低于正常值 (p = 0.01)，且癌基因和/或抑癌基因突变 (TP53/KRAS/EGFR) (p = 0.001) 富集。中位随访时间为 26.0 个月（范围：17.2-34.8 个月），一线免疫治疗后的中位无进展生存期 (PFS) 和总生存期 (OS) 为 9.0 个月（95% CI：5.0-13.0）和未达到（NR）。中性粒细胞与淋巴细胞比率 (NLR) 被确定为一线 PFS 的独立预后因素。一线免疫治疗后，与 NLR≥4 的患者相比，NLR≥4 的患者表现出更短的中位 PFS（7.0 个月 vs. NR；p = 0.033；95% CI：1.2-80.2）。接受一线免疫治疗的 50% 转移性 NSCLC 中，较低的 CD4/CD8 比率和基因突变的存在表明肿瘤反应减弱，而较高的 NLR 比率则表现出较差的中位 PFS。© 2024 作者。约翰·威利出版的《胸部癌症》

Patients with programmed cell death-ligand 1 (PD-L1) ≥50% metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy showed heterogeneous tumor responses. In this study, we investigated the clinical and immune-inflammatory markers distinguishing patients with metastatic NSCLC achieving high depth of tumor response (HDPR) from those with non-high depth of response (NHDPR). The impact of clinical features on the prognosis of patients with PD-L1 ≥50% were further clarified.The clinical characteristics and immune-inflammatory markers of 17 patients with PD-L1 ≥50% metastatic NSCLC at Beijing Tiantan Hospital between July 2020 and December 2023 were retrospectively analyzed.Among the 17 patients, seven (41.2%) patients achieved HDPR (range: -50%, -72%) and 10 (58.8%) patients achieved NHDPR (range: -13%, -45%). Below normal CD4 + T lymphocytes/CD8 + T lymphocytes (CD4/CD8) ratio (p = 0.01) and oncogenes and/or tumor suppressor gene mutations (TP53/KRAS/EGFR) (p = 0.001) were found enriched for NHDPR compared with HDPR. With a median follow-up of 26.0 months (range: 17.2-34.8 months), the median progression-free survival (PFS) following first-line immunotherapy and overall survival (OS) were 9.0 months (95% CI: 5.0-13.0) and not reached (NR), respectively. The neutrophil-to-lymphocyte ratio (NLR) was identified as an independent prognostic factor on first-line PFS. Patients with an NLR ≥4 exhibited a shorter median PFS (7.0 months vs. NR; p = 0.033; 95% CI: 1.2-80.2) than those with an NLR <4 following first-line immunotherapy.Among patients with PD-L1 ≥50% metastatic NSCLC who received first-line immunotherapy, a lower CD4/CD8 ratio and the presence of genes mutations showed a diminished tumor response and a higher NLR ratio exhibited a worse median PFS.© 2024 The Author(s). Thoracic Cancer published by John Wiley & Sons Australia, Ltd.