The Prognostic Value and Potential Mechanism of Tumor-Nutrition-Inflammation Index and Genes in Patients with Advanced Lung Cancer

Abstract

Background. Lung cancer (LC) has the highest mortality rate all over the world. It is necessary to search for novel potential biomarkers that are easily accessible and inexpensive in identifying patients with LC at early stage. Methods. A total of 195 patients with advanced LC who have received first-line chemotherapy were involved in this study. The optimized cut-off values of AGR and SIRI (AGR = albumin/globulin; SIRI = neutrophil  $\ast$  monocyte/lymphocyte) were determined by survival function analysis based on R software. COX regression analysis was performed to obtain the independent factors for establishing the nomogram model. A nomogram model comprising these independent prognostic parameters was built for the TNI (tumor-nutrition-inflammation index) score calculation. The predictive accuracy was demonstrated through ROC curve and calibration curves after index concordance. Results. The optimized cut-off values of AGR and SIRI were 1.22 and 1.60, respectively. It was revealed that liver metastasis, SCC, AGR, and SIRI were independent prognostic factors in advanced lung cancer by Cox analysis. Afterwards, the nomogram model comprised of these independent prognostic parameters was built for TNI scores calculation. Based on the TNI quartile values, patients were divided into four groups. And it was indicated that higher TNI had worse OS ( $P<0.05$ ) via Kaplan–Meier analysis and log-rank test. Moreover, the C-index and 1-year AUC area were 0.756 (0.723–0.788) and 75.62, respectively. There was high consistency shown in the calibration curves between predicted and actual survival proportions in the TNI model. In addition, tumor-nutrition-inflammation index and genes play an important role in LC development that might affect some pathways related to tumor development including cell cycle, homologous recombination, and P53 signaling pathway from a molecular level. Conclusion. TNI might be an analytical tool which was practical and precise for survival prediction of patients with advanced LC. Tumor-nutrition-inflammation index and genes play an important role in LC development. A preprint has previously been published [1].