Although the development of immune checkpoint inhibitors (ICI) such as pembrolizumab has dramatically improved survival for patients with metastatic non-small cell lung cancer (NSCLC), new predictive and prognostic indicators are still necessary. Between 2014 and 2019, researchers conducted a retrospective, 3-center analysis utilizing electronic medical record data for patients with stage IV NSCLC treated with first-line pembrolizumab as monotherapy or combined with chemotherapy. Variables were classified as covariates or confounders. Due to their developing predictive relevance, pretreatment body mass index (BMI), neutrophil-to-lymphocyte ratio (NLR), albumin, and antibiotic exposure as covariates. Confounding variables that highlighted characteristics of each patient and their cancer included sex, age at the beginning of immunotherapy, Programmed death-ligand 1 (PD-L1) expression, performance status (PS), tumor mutational burden, and whether pembrolizumab was administered alone or in combination with chemotherapy. Using the Kaplan-Meier method and Cox proportional hazards models, the relationship between these factors and time to treatment failure (TTF) and overall survival (OS) was evaluated. In the study, 136 were enrolled. TTF was correlated with antibiotics use, serum albumin, and NLR univariately. Serum albumin, NLR, and BMI were univariate studies related to OS. Adjusting for all 6 variables, the multivariate analysis revealed a substantial negative correlation between antibiotic use and TTF. Antibiotic use, albumin, neutrophil-lymphocyte ratio, and body mass index could predict treatment outcomes in patients with advanced NSCLC undergoing first-line immunotherapy.

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