Effect of body mass index and cholesterol‐rich apolipoprotein‐B‐containing lipoproteins on clinical outcome in NSCLC patients treated with immune checkpoint inhibitors‐based therapy: A retrospective analysis

Abstract Objectives Obesity and hypercholesterolemia are linked to unfavor clinical outcomes. Recent studies declared the paradox that high body mass index (BMI) and serum cholesterol were independently connected to better clinical outcome of immune checkpoint inhibitors (ICIs) monotherapy in non‐small cell lung cancer (NSCLC). The aim of the study is to investigate the prognosis of BMI and serum cholesterol in ICIs‐based therapy. Methods This is a retrospective study of 95 NSCLC patients treated with ICIs‐based therapy at the Department of Oncology and Lung Cancer Center of China‐Japan Friendship Hospital. Treatment efficacy was assessed using durable clinical benefit (DCB) versus nondurable benefit (NDB), best response (active vs. nonactive), and progression‐free survival (PFS). The prognostic value of BMI, LDL‐C, and RC was determined by multivariate regression analyses, while controlling for confounding factors including age, gender, diabetes status, smoking history, and statin usage. BMI was considered a confounding factor in the analysis when examining the impact of lipoproteins. Results In our study, we found that in the whole group, BMI ≥25 kg/m 2 was linked to a higher risk of poor therapeutic response (OR = 5.92, 95% CI 1.99–19.51, p .val = 0.002) and shorter progression‐free survival (HR = 3.00, 95% CI 1.59–5.68, p .val = 0.001). In addition, low levels of RC were associated with better therapeutic response (OR = 0.12, 95% CI 0.02–0.64, p .val = 0.019), while low levels of serum LDL‐C were found to predict longer PFS (HR = 0.40, 95% CI 0.19–0.82, p .val = 0.012). These associations were consistent in advanced NSCLC patients receiving ICIs and chemotherapy. Conclusions Our study suggest that BMI ≥25 kg/m 2 and elevated levels of apoB‐containing lipoproteins, including LDL‐C and RC, could potentially serve as useful prognostic markers for predicting poor treatment outcomes in advanced NSCLC patients treated with the combination of chemotherapy and ICIs.