Lactate dehydrogenase to albumin ratio as a potential indicator of pathological response and prognosis in non-small cell lung cancer patients undergoing neoadjuvant chemoimmunotherapy followed by surgery
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: In recent years, neoadjuvant chemoimmunotherapy followed by radical resection has become a new treatment option for non-small cell lung cancer (NSCLC). However, there remains a paucity of simple yet effective biomarkers for assessing pathological response and long-term prognosis. This study aimed to investigate the potential value of serum lactate dehydrogenase to albumin ratio (LAR) in this clinical setting. Methods: The clinicopathological data of 81 consecutive patients with NSCLC who received neoadjuvant chemoimmunotherapy and radical surgery at Xuanwu Hospital, Capital Medical University between January 2019 and December 2024 were retrospectively analyzed. Baseline LAR, post-treatment LAR, and the ratio of baseline to post-treatment LAR were calculated and evaluated for their associations with pathologic response and event-free survival (EFS). Results: Of the 81 patients, 48 (59.3%) achieved major pathological response (MPR). MPR patients had significantly lower post-treatment LAR and a higher baseline to post-treatment LAR ratio than non-MPR patients, whereas baseline LAR showed no significant difference. Post-treatment LAR and baseline to post-treatment LAR ratio discriminatedMPR with an area under the curve (AUC) of 0.747 and 0.719, respectively. Multivariate logistic regression identified post-treatment LAR [odds ratio (OR) =0.498, P=0.02] and radiological response (OR =6.297, P=0.008) as independent factors associated with MPR. Multivariate Cox regression demonstrated that higher post-treatment LAR [hazard ratio (HR) =1.664, P=0.003] and non-MPR status (HR =3.498, P=0.004) were independent prognostic factors for poor EFS. Restricted cubic spline (RCS) analysis further revealed a positive association between post-treatment LAR and EFS risk, with higher LAR corresponding to increased HRs. A nomogram based on these two EFS prognostic factors demonstrated good calibration at 24 months with internal bootstrap validation (C-index =0.769). Conclusions: Post-treatment LAR could serve as a potential indicator for response assessment and long-term prognostication in NSCLC patients undergoing neoadjuvant chemoimmunotherapy. Its simplicity, cost-effectiveness, and accessibility through routine laboratory testing render it a promising candidate for integration into clinical practice.
Source: Journal of Thoracic Disease
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224081889