Objective  To construct an inflammation-nutrition risk score (INRS) and its related nomogram based on inflammatory and nutritional indicators to predict the prognosis of advanced non-small cell lung cancer (NSCLC) patients treated with microwave ablation (MWA) combined with immunotherapy.

Methods  The clinical data of advanced NSCLC patients who underwent MWA combined immunotherapy in the department of thoracic surgery of Hubei Provincial Hospital of Integrated Chinese & Western Medicine from January 1, 2020 to December 31, 2021 were retrospectively analyzed. Patients were divided into a survival group and a death group based on the 2-year follow-up results. T-test, Chi-square test, or Fisher's exact test were used to select inflammatory indicators, nutritional indicators, and baseline data that showed statistical differences between the survival and death groups. Logistic regression was used to explore the relationship between the variables with statistical differences and the prognosis of patients with advanced NSCLC. The INRS and its related nomogram were constructed based on the results of multivariate Logistic regression. The predictive performance, calibration ability, and clinical applicability of the INRS and its related nomogram were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve.

Results  A total of 107 patients were included, including 80 patients in the survival group and 27 patients in the death group. The INRS, composed of systemic inflammatory reponse index (SIRI), monocyte to high density lipoprotein ratio (MHR), and hemoglobin-albumin-lymphocyte-platelet (HALP), had good predictive efficacy on predicting the death of patients with advanced NSCLC [area under the curve (AUC)=0.804, 95%CI: 0.710-0.898]. Weight loss of ≥5% (OR=4.56, 95%CI: 1.32-15.76, P=0.017), TNM stage (stage IV) (OR=4.34, 95%CI: 1.31-13.36, P=0.016) and INRS≥0.298 (OR=36.98, 95%CI: 8.12-168.43, P<0.001) were independent influencing factors for the 2-year mortality of patients with advanced NSCLC. The predictive efficacy of the INRS-related nomogram model for the 2-year mortality of patients with advanced NSCLC was further improved (AUC=0.891, 95%CI: 0.831-0.951). In addition, the calibration curve and decision curve indicated that the INRS-related nomogram has good calibration ability and clinical applicability.

Conclusion  The INRS is an effective biomarker for predicting the 2-year mortality risk of advanced NSCLC patients treated with MWA combined with immunotherapy. The INRS-related nomogram can serve as a simple and practical tool to reduce mortality in the follow-up management of advanced NSCLC patients treated with MWA combined with immunotherapy.

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