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Article

Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study

  • Authors:
    • Nedim Turan
    • Hacer Sahika Yildiz
    • Sedat Yildirim
    • Ezgi Turkoglu
    • Ugur Ozkerim
    • Sila Oksuz
    • Neslihan Buyukmurat
    • Hamit Bal
    • Heves Surmeli
    • Hatice Odabas
  • View Affiliations / Copyright

    Affiliations: Department of Medical Oncology, Faculty of Medicine, University of Health Sciences, Kartal Dr Lutfi Kırdar City Hospital, 34865 Istanbul, Türkiye, Department of Medical Oncology, Faculty of Medicine, Adıyaman Training and Research Hospital, 02040 Adıyaman, Türkiye, Department of Hospital Administration, Kartal Dr Lutfi Kırdar City Hospital, 34865 Istanbul, Türkiye
  • Article Number: 395
    |
    Published online on: July 7, 2026
       https://doi.org/10.3892/ol.2026.15750
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Abstract

The present study aimed to assess whether the baseline pan‑immune‑inflammation value (PIV), a readily available blood‑based marker, is linked to benefits from nivolumab treatment (response and survival) in patients with metastatic non‑small cell lung cancer (mNSCLC) receiving second‑line or later therapy. The data of 303 patients diagnosed with mNSCLC who received nivolumab at Kartal Dr Lütfi Kırdar City Hospital (Istanbul, Türkiye) between January 2022 and December 2023 were retrospectively reviewed. After excluding 33 ineligible cases, 270 patients were included in the final analysis. PIV was calculated from pre‑treatment peripheral blood counts. The median overall survival (OS) and progression‑free survival (PFS) times were assessed from the start of nivolumab treatment. Programmed death‑ligand 1 expression data were unavailable in this real‑world cohort, reflecting routine clinical practice. The median age was 63 years, and 84.1% of patients were male. The median OS and PFS times were 16 and 7 months, respectively. The patient responses were as follows: Progressive disease in 41.1%, partial response in 30.4%, stable disease in 22.2% and complete response in 6.3% of patients. Receiver operating characteristic analysis identified an optimal PIV cut‑off of 604.5 for predicting nivolumab response. Patients with low PIV values had significantly longer median OS (25 vs. 11 months) and PFS (9 vs. 5 months) times, and a lower rate of nivolumab resistance (38.7 vs. 61.3%; P<0.001). Baseline PIV was confirmed as a significant predictor of nivolumab response (specificity, 62.9%; sensitivity, 61.3%; P<0.001). Upon multivariate logistic regression analysis, high PIV, blood group B antigen, Eastern Cooperative Oncology Group performance status 2 and lack of response to prior chemotherapy were identified as independent predictors of nivolumab resistance. In this real‑world cohort, results were consistent with the known activity of nivolumab in previously treated mNSCLC. Baseline PIV was associated with treatment outcomes and may serve as a convenient, blood‑based marker to inform immunotherapy decision‑making. Further prospective validation is needed before routine clinical use.
View Figures

Figure 1

Receiver operating characteristic
curves showing the performance of baseline PIV and the combined
model (PIV + blood type) in predicting nivolumab resistance. Area
under the curve, sensitivity and specificity are presented. The PIV
cut-off was determined using the Youden index. PIV,
pan-immune-inflammation value.

Figure 2

Kaplan-Meier curves for OS stratified
by PIV groups (cut-off, 604.5). Median OS is shown. Groups were
compared using the log-rank test. OS, overall survival; PIV,
pan-immune-inflammation value.

Figure 3

Kaplan-Meier curves for PFS stratified
by PIV groups (cut-off, 604.5). Median PFS is shown. Groups were
compared using the log-rank test. PFS, progression-free survival;
PIV, pan-immune-inflammation value.
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Copy and paste a formatted citation
Spandidos Publications style
Turan N, Yildiz HS, Yildirim S, Turkoglu E, Ozkerim U, Oksuz S, Buyukmurat N, Bal H, Surmeli H, Odabas H, Odabas H, et al: Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study. Oncol Lett 32: 395, 2026.
APA
Turan, N., Yildiz, H.S., Yildirim, S., Turkoglu, E., Ozkerim, U., Oksuz, S. ... Odabas, H. (2026). Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study. Oncology Letters, 32, 395. https://doi.org/10.3892/ol.2026.15750
MLA
Turan, N., Yildiz, H. S., Yildirim, S., Turkoglu, E., Ozkerim, U., Oksuz, S., Buyukmurat, N., Bal, H., Surmeli, H., Odabas, H."Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study". Oncology Letters 32.3 (2026): 395.
Chicago
Turan, N., Yildiz, H. S., Yildirim, S., Turkoglu, E., Ozkerim, U., Oksuz, S., Buyukmurat, N., Bal, H., Surmeli, H., Odabas, H."Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study". Oncology Letters 32, no. 3 (2026): 395. https://doi.org/10.3892/ol.2026.15750
Copy and paste a formatted citation
x
Spandidos Publications style
Turan N, Yildiz HS, Yildirim S, Turkoglu E, Ozkerim U, Oksuz S, Buyukmurat N, Bal H, Surmeli H, Odabas H, Odabas H, et al: Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study. Oncol Lett 32: 395, 2026.
APA
Turan, N., Yildiz, H.S., Yildirim, S., Turkoglu, E., Ozkerim, U., Oksuz, S. ... Odabas, H. (2026). Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study. Oncology Letters, 32, 395. https://doi.org/10.3892/ol.2026.15750
MLA
Turan, N., Yildiz, H. S., Yildirim, S., Turkoglu, E., Ozkerim, U., Oksuz, S., Buyukmurat, N., Bal, H., Surmeli, H., Odabas, H."Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study". Oncology Letters 32.3 (2026): 395.
Chicago
Turan, N., Yildiz, H. S., Yildirim, S., Turkoglu, E., Ozkerim, U., Oksuz, S., Buyukmurat, N., Bal, H., Surmeli, H., Odabas, H."Pan‑immune‑inflammation value as a prognostic and predictive biomarker in metastatic non‑small cell lung cancer treated with nivolumab: A real‑world study". Oncology Letters 32, no. 3 (2026): 395. https://doi.org/10.3892/ol.2026.15750
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