Prognostic Factors in Non-small Cell Lung Cancer Patients Treated With Immune Checkpoint Inhibitors.

[BACKGROUND/AIM] Immune checkpoint inhibitors (ICIs) have emerged as a first-line treatment for advanced non-small cell lung cancer (NSCLC), offering the potential for long-term survival. However, predictors of sustained clinical benefit in patients without driver gene mutations remain poorly defined. This study aimed to identify clinical and therapeutic factors associated with long-term survival in NSCLC patients treated with ICIs.

[PATIENTS AND METHODS] We retrospectively analyzed 97 NSCLC patients treated with ICIs. Patients who survived for >3 years were classified as the long-term survival group, and those who did not were categorized as the non-long-term survival group. Clinical characteristics and treatment-related factors were compared between these two groups.

[RESULTS] Of the 97 patients, 22 (22.7%) were classified into the long-term survival group. This group included a higher proportion of younger patients, patients who responded to initial ICI therapy, and patients who discontinued treatment due to immune-related adverse events (irAEs). Multivariate analysis identified younger age and low neutrophil-to-lymphocyte ratio (NLR) as independent predictors of long-term survival. Adenocarcinoma histology and switching administration of ICIs (, changing from a PD-1 to a PD-L1 inhibitor or ) showed clinically suggestive, though marginally significant, associations with prolonged survival.

[CONCLUSION] Younger age and low NLR were associated with long-term survival in NSCLC patients treated with ICIs. Adenocarcinoma and switching administration may have potential clinical relevance. These findings highlight the importance of patient selection and strategic management of ICI therapy. Nevertheless, confirmation in larger prospective cohorts is warranted.