An integrated host vulnerability score is associated with survival in advanced NSCLC treated with nivolumab: a PET/CT-based real-world study.

Authors

Vali Aliyev, Murad Guliyev, Mehmet Cem Fidan, Zeliha Birsin, Murat Günaltılı, Emir Çerme, Selin Cebeci, Hamza Abbasov, Said Erkam Bıyıkoğlu, Onur Erdem Şahin, Muhammet Sait Sağer, Nebi Serkan Demirci, Özkan Alan

Published in

BMC pulmonary medicine. Jul 16, 2026. Epub Jul 16, 2026.

Abstract

Clinical outcomes in advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors remain heterogeneous, and simple prognostic tools for patient stratification are limited. We aimed to evaluate a multidimensional host vulnerability score integrating systemic inflammation, nutritional status, and skeletal muscle depletion in patients receiving second-line nivolumab in a real-world setting.
In this retrospective study, 110 patients with advanced NSCLC treated with second-line nivolumab were included. A composite score was constructed using neutrophil-to-lymphocyte ratio (NLR), serum albumin, and skeletal muscle index (SMI) derived from pretreatment PET/CT. Patients were stratified into lower-risk (score 0-1) and higher-risk (score 2-3) groups. Survival outcomes were assessed using Kaplan-Meier analysis, Cox proportional hazards models, and model discrimination analyses.
High-risk patients had significantly shorter progression-free survival (median 3.4 vs. 5.9 months; HR 1.68, 95% CI 1.10-2.59; p = 0.017) and overall survival (median 7.2 vs. 14.5 months; HR 2.08, 95% CI 1.30-3.31; p = 0.002) compared with the low-risk group. In model comparison analyses, the ordinal composite score showed the clearest improvement in prognostic discrimination for overall survival, whereas its incremental value for progression-free survival was more modest.
A multidimensional host vulnerability score integrating inflammatory, nutritional, and body composition domains was associated with survival outcomes in advanced NSCLC treated with nivolumab. This score may support real-world prognostic risk stratification, particularly for overall survival, but requires prospective and external validation before clinical implementation.

PMID:
42458381
Bibliographic data and abstract were imported from PubMed on 16 Jul 2026.

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