BACKGROUND: Lung cancer is the leading cause of cancer-related death, of which 
non-small cell lung cancer (NSCLC) is the most common type. Immune checkpoint 
inhibitors (ICIs) have now become one of the main treatments for advanced NSCLC. 
This paper retrospectively investigated the effect of peripheral blood 
inflammatory indexes on the efficacy of immunotherapy and survival of patients 
with advanced non-small cell lung cancer, in order to find strategies to guide 
immunotherapy in NSCLC.
METHODS: Patients with advanced non-small cell lung cancer who were hospitalized 
in The Affiliated Cancer Hospital of Nanjing Medical University from October 
2018 to August 2019 were selected to receive anti-PD-1 (pembrolizumab, 
sintilimab or toripalimab) monotherapy or combination regimens. And were 
followed up until 10 December 2020, and the efficacy was evaluated according to 
RECIST1.1 criteria. Progression-free survival (PFS) and overall survival (OS) 
were followed up for survival analysis. A clinical prediction model was 
constructed to analyze the predictive value of neutrophil-to-lymphocyte ratio 
(NLR) based on NLR data at three different time points: before treatment, 6 
weeks after treatment and 12 weeks after treatment (0w, 6w and 12w), and the 
accuracy of the model was verified.
RESULTS: 173 patients were finally included, all of whom received the above 
treatment regimen, were followed up for a median of 19.7 months. The objective 
response rate (ORR) was 27.7% (48/173), the disease control rate (DCR) was 89.6% 
(155/173), the median PFS was 8.3 months (7.491-9.109) and the median OS was 
15.5 months (14.087-16.913). The chi-square test and logistic multi-factor 
analysis showed that NLR6w was associated with ORR and NLR12w was associated 
with ORR and DCR. Further Cox regression analysis showed that NLR6w and NLR12w 
affected PFS and NLR0w, NLR6w and NLR12w were associated with OS.
CONCLUSIONS: In patients with advanced non-small cell lung cancer, NLR values at 
different time points are valid predictors of response to immunotherapy, and NLR 
<3 is often associated with a good prognosis.