Prospective evaluation of the pan-immune-inflammation value (PIV) as an independent prognostic biomarker in EGFR-mutated advanced non-small cell lung cancer.

Abstract

e20512 Background: EGFR mutations are frequent in Non-Small Cell Lung Cancer (NSCLC), with an estimated prevalence of 38.8% in the Asian population. In resource-constrained countries like India, the combination of Tyrosine Kinase Inhibitors (TKI) plus chemotherapy remains the optimal treatment strategy. However, survival outcomes in EGFR-mutated NSCLC remain heterogeneous. Systemic inflammation significantly influences cancer progression and treatment response. The Pan-Immune-Inflammation Value (PIV)—derived from peripheral blood counts has emerged as a potential prognostic biomarker. Evaluating its utility in patients with EGFR-mutated NSCLC receiving TKI with chemotherapy is essential for better patient stratification. Methods: In this prospective study, 165 treatment-naïve patients with EGFR-mutated (Exon 19del or L858R) NSCLC were enrolled. Participants received first-line Tyrosine Kinase Inhibitors (TKIs) combined with platinum-based chemotherapy. Baseline Pan-Immune-Inflammation Value (PIV) was calculated from absolute peripheral blood counts: (Neutrophils × Platelets × Monocytes) / Lymphocytes. Survival outcomes, including Overall Survival (OS) and Progression-Free Survival (PFS), were analyzed using the Kaplan-Meier method and Log-rank test. Spearman Rank Correlation (ρ) assessed the relationship between PIV and survival duration. A multivariate Cox proportional hazards model was utilized to determine the independent prognostic value of PIV, adjusting for ECOG performance status and brain metastasis. Results: The median follow-up for the cohort was 26 months. The most frequent molecular alterations were Exon 19 deletions (57.8%) and L858R substitutions (25.5%). The survival outcomes for the entire population (n = 165) showed a 2-year OS rate of 71.78% (median OS: 26.31 months) and a 2-year PFS rate of 27.04% (median: 19.05 months). In the univariate analysis, higher baseline PIV, ECOG performance status ≥ 2, and the presence of brain metastasis were significantly associated with shorter PFS and OS (p < 0.05). In the multivariate cox regression model, high baseline PIV remained a significant independent predictor of poorer outcomes. For OS, high PIV was associated with a hazard ratio (HR) of 2.42 (95% ci: 1.68–3.49; p < 0.001), while for PFS, the HR was 2.18 (95% ci: 1.54–3.08; p < 0.001). These findings indicate that systemic inflammation, as measured by PIV, independently influences survival regardless of other clinical factors. Conclusions: Baseline PIV can be a powerful, non-invasive, and cost-effective independent prognostic biomarker in EGFR-mutated NSCLC and could be utilized in clinical practice to identify patients who may benefit from combination therapeutic strategies beyond standard TKI monotherapy.