RNF43 in cancer: Molecular understanding and clinical significance in immunotherapy.

Identifying biomarkers to predict immune checkpoint inhibitor (ICI) efficacy is warranted. Considering that somatic mutation-derived neoantigens induce strong immune responses, patients with a high tumor mutational burden reportedly tend to respond to ICIs. Therefore, the original function of neoantigenic mutations and their impact on the tumor microenvironment (TME) require attention. RNF43 is a type of RING E3 ubiquitin ligase, and long-term survivors in most cancers had conserved patterns of mutations of RNF43. Also, high microsatellite instability patients had a higher RNF43 mutation rate compared with microsatellite stability tumor patients, who were more sensitive to ICI treatment. Therefore, RNF43 has become a promising biomarker of immunotherapy in a wide range of cancers. This review focuses on the up-to-date knowledge of RNF43 mutation in cancer. We summarize the cancer hallmarks involving activities regulated by RNF43 and highlight its extremely sophisticated regulation of WNT signaling and tumor microenvironment. The key genes interacting with RNF43 have also been summarized and discussed. Additionally, we highlight and propose new strategies of targeting RNF43 and RNF43-based combinations with established immunotherapy and combination therapy. These efforts may provide new perspectives for RNF43-based target therapy in cancer.

Oxytocin Attenuates Sympathetic Innervation with Inhibition of Cardiac Mast Cell Degranulation in Rats after Myocardial Infarction.

Sympathetic hyperinnervation is the leading cause of fatal ventricular arrhythmia (VA) after myocardial infarction (MI). Cardiac mast cells cause arrhythmias directly through degranulation. However, the role and mechanism of mast cell degranulation in sympathetic remodeling remain unknown. We investigated the role of oxytocin (OT) in stabilizing cardiac mast cells and improving sympathetic innervation in rats. MI was induced by coronary artery ligation. Western blotting, immunofluorescence, and toluidine staining of mast cells were performed to determine the expression and location of target protein. Mast cells accumulated significantly in peri-infarcted tissues and were present in a degranulated state. They expressed OT receptor (OTR), and OT infusion reduced the number of degranulated cardiac mast cells post-MI. Sympathetic hyperinnervation was attenuated as assessed by immunofluorescence for tyrosine hydroxylase (TH). Seven days post-MI, the arrhythmia score of programmed electrical stimulation was higher in vehicle-treated rats with MI than in rats treated with OT. An in vitro study showed that OT stabilized mast cells via the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) signaling pathway. Further in vivo studies on OTR-deficient mice showed worsening mast cell degranulation and worsening sympathetic innervation. OT pretreatment inhibited cardiac mast cell degranulation post-MI and prevented sympathetic hyperinnervation, along with mast cell stabilization via the PI3K/Akt pathway. SIGNIFICANCE STATEMENT: This is the first study to elucidate the role and mechanism of oxytocin (OT) in inflammatory-sympathetic communication mediated sympathetic hyperinnervation after myocardial infarction (MI), providing new approaches to prevent fatal arrhythmias.

Relative mobility of screw versus edge dislocations controls the ductile-to-brittle transition in metals.

Body-centered cubic metals including steels and refractory metals suffer from an abrupt ductile-to-brittle transition (DBT) at a critical temperature, hampering their performance and applications. Temperature-dependent dislocation mobility and dislocation nucleation have been proposed as the potential factors responsible for the DBT. However, the origin of this sudden switch from toughness to brittleness still remains a mystery. Here, we discover that the ratio of screw dislocation velocity to edge dislocation velocity is a controlling factor responsible for the DBT. A physical model was conceived to correlate the efficiency of Frank-Read dislocation source with the relative mobility of screw versus edge dislocations. A sufficiently high relative mobility is a prerequisite for the coordinated movement of screw and edge segments to sustain dislocation multiplication. Nanoindentation experiments found that DBT in chromium requires a critical mobility ratio of 0.7, above which the dislocation sources transition from disposable to regeneratable ones. The proposed model is also supported by the experimental results of iron, tungsten, and aluminum.

Effect of photodynamic therapy mediated by hematoporphyrin derivatives on small cell lung cancer H446 cells and bronchial epithelial BEAS-2B cells.

To investigate the effects of photodynamic therapy (PDT) mediated by hematoporphyrin derivatives (HPD) on the proliferation of small cell lung cancer H446 cells and bronchial epithelial BEAS-2B cells. H446 cells and BEAS-2B cells were cultured in vitro with different concentrations of HPD(0, 5, 10, 12, 15, 20 µg/mL) for 4 h, and then irradiated with 630 nm laser with different energy densities (0, 25, 50, 75, 100 mW/cm2). Cell viability of H446 cells and BEAS-2B cells were detected by CCK8 assay. The cell apoptosis was observed with Annexin V-FTTC/PI double staining and Hoechst 33258. The RT-PCR examination was applied to detect the transcriptional changes of the mRNA of Bax、Bcl-2, and Caspase-9. The results of CCK8 showed that when the HPD was 15 µg/mL and the laser power density reached 50 mW/cm2, the cell viability was significantly decreased compared with the black control group. Hoechst 33258 staining showed that with the increase of HPD concentration, the cell density was reduced, and apoptotic cells increased. Flow cytometry assay revealed that the apoptotic rates of the HPD-PDT group of H446 cells and BEAS-2B cells were significantly different from those of the blank control group. The RT-PCR examination showed that the expression levels of Bax and Caspase-9 mRNA in the HPD-PDT group were up-regulated, while the expression levels of Bcl-2 mRNA were down-regulated significantly. HPD-PDT can inhibit H446 cells and BEAS-2B cells growth. The mechanism may be related to up-regulating the expression levels of Bax and Caspase-9 mRNA and down-regulating the expression levels of Bcl-2 mRNA.

Direct Observation of Vacancy-Cluster-Mediated Hydride Nucleation and the Anomalous Precipitation Memory Effect in Zirconium.

Controlling the heterogeneous nucleation of new phases is of importance in tuning the microstructures and properties of materials. However, the role of vacancy-a popular defect in materials that is hard to be resolved under conventional electron microscopy-in the heterogeneous phase nucleation remains intriguing. Here, this work captures direct in situ experimental evidences that vacancy clusters promote the heterogeneous hydride nucleation and cause the anomalous precipitation memory effect in zirconium. Both interstitial and vacancy dislocation loops form after hydride dissolution. Interestingly, hydride reprecipitation only occurs on those vacancy loop decorated sites during cooling. Atomistic simulations reveal that hydrogen atoms are preferentially segregated at individual vacancy and vacancy clusters, which assist hydride nucleation, and stimulate the unusual memory effect during hydride reprecipitation. The finding breaks the traditional view on the sequence of heterogeneous nucleation sites and sheds light on the solid phase transformation related to vacancy-sensitive alloying elements.

Dislocation-Mediated Hydride Precipitation in Zirconium.

The formation of hydrides challenges the integrity of zirconium (Zr) fuel cladding in nuclear reactors. The dynamics of hydride precipitation are complex. Especially, the formation of the butterfly or bird-nest configurations of dislocation structures around hydride is rather intriguing. By in-situ transmission electron microscopy experiments and density functional theory simulations, it is discovered that hydride growth is a hybrid displacive-diffusive process, which is regulated by intermittent dislocation emissions. A strong tensile stress field around the hydride tip increases the solubility of hydrogen in Zr matrix, which prevents hydride growth. Punching-out dislocations reduces the tensile stress surrounding the hydride, decreases hydrogen solubility, reboots the hydride precipitation and accelerates the growth of the hydride. The emission of dislocations mediates hydride growth, and finally, the consecutively emitted dislocations evolve into a butterfly or bird-nest configuration around the hydride.

Atomic-Scale Hidden Point-Defect Complexes Induce Ultrahigh-Irradiation Hardening in Tungsten.

Tungsten displays high strength in extreme temperature and radiation environments and is considered a promising plasma facing material for fusion nuclear reactors. Unlike other metals, it experiences substantial irradiation hardening, which limits service life and presents safety concerns. The origin of ultrahigh-irradiation hardening in tungsten cannot be well-explained by conventional strengthening theories. Here, we demonstrate that irradiation leads to near 3-fold increases in strength, while the usual defects that are generated only contribute less than one-third of the hardening. An analysis of the distribution of tagged atom-helium ions reveals that more than 87% of vacancies and helium atoms are unaccounted for. A large fraction of helium-vacancy complexes are frozen in the lattice due to high vacancy migration energies. Through a combination of in situ nanomechanical tests and atomistic calculations, we provide evidence that irradiation hardening mainly originates from high densities of atomic-scale hidden point-defect complexes.

Hierarchical 3D Nanolayered Duplex-Phase Zr with High Strength, Strain Hardening, and Ductility.

Nanolayered, bimetallic composites are receiving increased attention due to an exceptional combination of strength and thermal stability not possible from their coarse-layered counterparts or constituents alone. Yet, due to their 2D planar, unidirectional arrangement, they are highly anisotropic, which results in limited strain hardening and ductility. Therefore, like many high-performance, ultrastrong materials of our time, they succumb to the usual strength-ductility trade-offs. Here we present the formation of a novel hierarchical microstructure, comprised of crystals consisting of 3D nanolayered α/ß-Zr networks. By direct comparison with coarse-layered material of the same chemistry, we show that the unusual hierarchical 3D structure gives rise to high strain hardening, high strength, and high ductility. Using TEM analysis and hysteresis testing, we discovered that the 3D randomly oriented biphase boundaries result in progressively dispersive rather than localized slip with increasing strain. Dislocation activity in the α-Zr lamellae transitions from single slip to multislip and eventually to multimodal slip as strain increases. The diffusive slip-promoting properties of 3D layered networks can potentially invoke simultaneous high strength, strain hardening, and ductility, and reveal a new target in the microstructural design of high performance structural materials.

Liquid-Like, Self-Healing Aluminum Oxide during Deformation at Room Temperature.

Effective protection from environmental degradation relies on the integrity of oxide as diffusion barriers. Ideally, the passivation layer can repair its own breaches quickly under deformation. While studies suggest that the native aluminum oxide may manifest such properties, it has yet to be experimentally proven because direct observations of the air-environmental deformation of aluminum oxide and its initial formation at room temperature are challenging. Here, we report in situ experiments to stretch pure aluminum nanotips under O2 gas environments in a transmission electron microscope (TEM). We discovered that aluminum oxide indeed deforms like liquid and can match the deformation of Al without any cracks/spallation at moderate strain rate. At higher strain rate, we exposed fresh metal surface, and visualized the self-healing process of aluminum oxide at atomic resolution. Unlike traditional thin-film growth or nanoglass consolidation processes, we observe seamless coalescence of new oxide islands without forming any glass-glass interface or surface grooves, indicating greatly accelerated glass kinetics at the surface compared to the bulk.

Ox-LDL induces endothelial cell apoptosis and macrophage migration by regulating caveolin-1 phosphorylation.

Oxidative low-density lipoprotein (ox-LDL) is a risk factor for atherosclerosis. Ox-LDL leads to endothelial injury in the initial stage of atherosclerosis. In this study, we investigated the role of ox-LDL in endothelial injury and macrophage recruitment. We demonstrated that ox-LDL promoted a dose-dependent phosphorylation of caveolin-1 in human umbilical vein endothelial cells. Phosphorylated caveolin-1 increased ox-LDL uptake. Intracellular accumulation of ox-LDL induced NF-κB p65 phosphorylation, promoted HMGB1 translocation from nucleus to cytoplasm and cytochrome C release from mitochondria to cytoplasm, and activated caspase 3, resulting in cell apoptosis. NF-κB activation also facilitated cavolin-1 phosphorylation and HMGB1 expression. In addition, caveolin-1 phosphorylation favored HMGB1 release and nuclear translocation of EGR1. Nuclear translocation of EGR1 contributed to cytoplasmic translocation of HMGB1. The extracellular HMGB1 induced the migration of PMBC-derived macrophages toward HUVECs in a TLR4-dependent manner. Our results suggested that ox-LDL promoted HUVECs apoptosis and macrophage recruitment by regulating caveolin-1 phosphorylation.

Helium Nanobubbles Enhance Superelasticity and Retard Shear Localization in Small-Volume Shape Memory Alloy.

The intriguing phenomenon of metal superelasticity relies on stress-induced martensitic transformation (SIMT), which is well-known to be governed by developing cooperative strain accommodation at multiple length scales. It is therefore scientifically interesting to see what happens when this natural length scale hierarchy is disrupted. One method is producing pillars that confine the sample volume to micrometer length scale. Here we apply yet another intervention, helium nanobubbles injection, which produces porosity on the order of several nanometers. While the pillar confinement suppresses superelasticity, we found the dispersion of 5-10 nm helium nanobubbles do the opposite of promoting superelasticity in a Ni53.5Fe19.5Ga27 shape memory alloy. The role of helium nanobubbles in modulating the competition between ordinary dislocation slip plasticity and SIMT is discussed.

Radiation-Induced Helium Nanobubbles Enhance Ductility in Submicron-Sized Single-Crystalline Copper.

The workability and ductility of metals usually degrade with exposure to irradiation, hence the phrase "radiation damage". Here, we found that helium (He) radiation can actually enhance the room-temperature deformability of submicron-sized copper. In particular, Cu single crystals with diameter of 100-300 nm and containing numerous pressurized sub-10 nm He bubbles become stronger, more stable in plastic flow and ductile in tension, compared to fully dense samples of the same dimensions that tend to display plastic instability (strain bursts). The sub-10 nm He bubbles are seen to be dislocation sources as well as shearable obstacles, which promote dislocation storage and reduce dislocation mean free path, thus contributing to more homogeneous and stable plasticity. Failure happens abruptly only after significant bubble coalescence. The current findings can be explained in light of Weibull statistics of failure and the beneficial effects of bubbles on plasticity. These results shed light on plasticity and damage developments in metals and could open new avenues for making mechanically robust nano- and microstructures by ion beam processing and He bubble engineering.

Nanobubble Fragmentation and Bubble-Free-Channel Shear Localization in Helium-Irradiated Submicron-Sized Copper.

Helium bubbles are one of the typical radiation microstructures in metals and alloys, significantly influencing their deformation behavior. However, the dynamic evolution of helium bubbles under straining is less explored so far. Here, by using in situ micromechanical testing inside a transmission electron microscope, we discover that the helium bubble not only can coalesce with adjacent bubbles, but also can split into several nanoscale bubbles under tension. Alignment of the splittings along a slip line can create a bubble-free channel, which appears softer, promotes shear localization, and accelerates the failure in the shearing-off mode. Detailed analyses unveil that the unexpected bubble fragmentation is mediated by the combination of dislocation cutting and internal surface diffusion, which is an alternative microdamage mechanism of helium irradiated copper besides the bubble coalescence.

Uncovering the Intrinsic High Fracture Toughness of Titanium via Lowered Oxygen Impurity Content.

Titanium (Ti) and its alloys are known to exhibit room-temperature fracture toughness below 130 MPa m1/2, only about one half of the best austenitic stainless steels. It is purported that this is not the best possible fracture resistance of Ti, but a result of oxygen impurities that sensitively retard the activities of plasticity carriers in this hexagonal close-packed metal. By a reduction of oxygen content from the 0.14 wt% in commercial purity Ti to 0.02 wt%, the mode-Ι fracture toughness of the low-oxygen Ti is measured to be as high as KJ Ic ≈ 255 MPa m1/2, corresponding to J-integral-based crack-initiation toughness of up to JIc ≈ 537 kJ m-2. This extraordinary toughness, reported here for the first time for pure Ti, places Ti among the toughest known materials. The intrinsic high fracture resistance is attributed to the profuse plastic deformation in a significantly enlarged plastic zone, rendered by the pronounced deformation twinning ahead of the crack tip along with ample twin-stimulated 〈c+a〉 dislocation activities, in the absence of impeding oxygen. Controlling the content of a property-controlling impurity thus holds the promise to be a readily applicable strategy to reach for unprecedented damage tolerance in some other structural alloys.

Preparation, Deformation Behavior and Irradiation Damage of Refractory Metal Single Crystals for Nuclear Applications: A Review.

Refractory metal single crystals have been applied in key high-temperature structural components of advanced nuclear reactor power systems, due to their excellent high-temperature properties and outstanding compatibility with nuclear fuels. Although electron beam floating zone melting and plasma arc melting techniques can prepare large-size oriented refractory metals and their alloy single crystals, both have difficulty producing perfect defect-free single crystals because of the high-temperature gradient. The mechanical properties of refractory metal single crystals under different loads all exhibit strong temperature and crystal orientation dependence. Slip and twinning are the two basic deformation mechanisms of refractory metal single crystals, in which low temperatures or high strain rates are more likely to induce twinning. Recrystallization is always induced by the combined action of deformation and annealing, exhibiting a strong crystal orientation dependence. The irradiation hardening and neutron embrittlement appear after exposure to irradiation damage and degrade the material properties, attributed to vacancies, dislocation loops, precipitates, and other irradiation defects, hindering dislocation motion. This paper reviews the research progress of refractory metal single crystals from three aspects, preparation technology, deformation behavior, and irradiation damage, and highlights key directions for future research. Finally, future research directions are prospected to provide a reference for the design and development of refractory metal single crystals for nuclear applications.

Efficacy of immunotherapy in HER2-mutated non-small cell lung cancer: a single-arm meta-analysis.

BACKGROUND: Non-small cell lung cancers (NSCLC) harboring Human Epidermal Growth Factor Receptor 2 (HER2) mutations represent a distinct subset with unique therapeutic challenges. Although immune checkpoint inhibitors (ICIs) have been transformative in lung cancer treatment, the efficacy of ICIs in HER2-mutated NSCLC remains to be established. METHODS: We systematically searched for real-world studies investigating the use of ICIs in treating HER2-mutated NSCLC, sourced from the PubMed, Cochrane Library, and Embase databases. Outcomes including objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS) were extracted for further analysis. RESULTS: Twelve studies involving 260 patients were enrolled in this meta-analysis. Pooled data revealed an ORR of 0.26 (95% CI 0.17-0.34), a DCR of 0.68 (95% CI 0.55-0.81), and a median PFS (mPFS) of 5.36 months (95% CI 3.50-7.21). Notably, in the subgroup receiving combined immune and chemotherapy, the ORR increased to 0.37 (95% CI 0.26-0.49), the DCR to 0.79 (95% CI 0.70-0.87), and the mPFS to 7.10 months (95% CI 5.21-8.99). CONCLUSIONS: ICIs demonstrate promising anti-tumor activity and safety in patients with HER2-mutated NSCLC. Furthermore, the combined regimen of ICIs and chemotherapy may provide a significant therapeutic option for this patient population.

Deciphering the Dynamics of EGFR-TKI Resistance in Lung Cancer: Insights from Bibliometric Analysis.

Background: EGFR-TKI resistance poses a significant challenge in the treatment landscape of non-small cell lung cancer (NSCLC), prompting extensive research into mechanisms and therapeutic strategies. In this study, we conduct a bibliometric analysis to elucidate evolving research hotspots and trends in EGFR-TKI resistance, offering insights for clinical interventions and scientific inquiries. Methods: Publications spanning from 1996 to 2024, focusing on EGFR-TKI resistance in NSCLC, were sourced from the Web of Science Core Collection. Utilizing VOSviewer 1.6.19, CiteSpace 6.2. R2, and Scimago Graphica 1.0.35, we analyzed these articles to identify countries/regions and institutions, Journals, publications, key contributors, collaborations, and emerging topics. Results: An analysis of 8051 articles by 38,215 researchers from 86 countries shows growing interest in EGFR-TKI resistance mechanisms. Since 1996, publications have steadily increased, surpassing 500 per year after 2016, with a sharp rise in citations. Research articles make up 84% of publications, emphasizing scholarly focus. Global collaboration, especially among researchers in China, the US, and Japan, is strong. Leading institutions like Dana-Farber and Harvard, along with journals such as "Lung Cancer", are key in sharing findings. Professors Yi-Long Wu and William Pao are prominent contributors. Keyword analysis reveals core themes, including first-generation EGFR-TKIs, emerging agents like osimertinib, and research on the T790M mutation. Conclusion: EGFR-TKI resistance remains a critical issue in NSCLC treatment, driving ongoing research efforts worldwide. Focusing future research on clear identification of resistance mechanisms will guide post-resistance treatment strategies, necessitating further exploration, alongside the validation of emerging drugs through clinical trials. Moreover, "chemo+" treatments following EGFR-TKI resistance require more clinical data and real-world evidence for assessing safety and patient outcomes. As research advances, a multidisciplinary approach will be key to overcoming these challenges. Continued innovation in treatment could greatly enhance patient survival and quality of life.

SMARCA4 mutations and expression in lung adenocarcinoma: prognostic significance and impact on the immunotherapy response.

The switch/sucrose non-fermenting (SWI/SNF) complex family includes important chromatin-remodeling factors that are frequently mutated in lung adenocarcinoma (LUAD). However, the role of one family member, SMARCA4, in LUAD prognosis and immunotherapy sensitivity remains unclear. In the present study, 6745 LUAD samples from the cBioPortal database were used to analyze the relationships between SMARCA4 mutations and patient prognoses and clinical characteristics. Additionally, we examined the correlation between SMARCA4 mutations and prognosis in patients treated with immunotherapy using two immune-related datasets. SMARCA4 mutations and low expression were associated with shorter survival, and mutations were associated with a high tumor mutational burden and high microsatellite instability. SMARCA4 mutations were accompanied by KRAS, KEAP1, TP53 and STK11 mutations. No significant difference was observed in the immunotherapy response between patients with and without SMARCA4 mutations. When KRAS or STK11 mutations were present, immunotherapy effectiveness was poorer; however, when both SMARCA4 and TP53 mutations were present, immunotherapy was more effective. Furthermore, low SMARCA4 expression predicted a higher immunophenoscore, and SMARCA4 expression was correlated with certain immune microenvironment features. Taken together, our results suggest that SMARCA4 mutations and low expression might be associated with poor LUAD prognosis. Additionally, immunotherapy efficacy in patients with SMARCA4 mutations depended on the co-mutant genes. Thus, SMARCA4 could be an important factor to be considered for LUAD diagnosis and treatment.

Competitive-like binding between carbon black and CTNNB1 to ΔNp63 interpreting the abnormal respiratory epithelial repair after injury.

Airway epithelium is extraordinary vulnerable to damage owning to continuous environment exposure. Subsequent repair is therefore essential to restore the homeostasis of respiratory system. Disruptions in respiratory epithelial repair caused by nanoparticles exposure have been linked to various human diseases, yet implications in repair process remain incompletely elucidated. This study aims to elucidate the key stage in epithelial repair disturbed by carbon black (CB) nanoparticles, highlighting the pivotal role of ΔNp63 in mediating the epithelium repair. A competitive-like binding between CB and beta-catenin 1 (CTNNB1) to ΔNp63 is proposed to elaborate the underlying toxicity mechanism. Specifically, CB exhibits a remarkable inhibitory effect on cell proliferation, leading to aberrant airway epithelial repair, as validated in air-liquid culture. ΔNp63 drives efficient epithelial proliferation during CB exposure, and CTNNB1 was identified as a target of ΔNp63 by bioinformatics analysis. Further molecular dynamics simulation reveals that oxygen-containing functional groups on CB disrupt the native interaction of CTNNB1 with ΔNp63 through competitive-like binding pattern. This process modulates CTNNB1 expression, ultimately restraining proliferation during respiratory epithelial repair. Overall, the current study elucidates that the diminished interaction between CTNNB1 and ΔNp63 impedes respiratory epithelial repair in response to CB exposure, thereby enriching the public health risk assessment on CB-related respiratory diseases.

Prognostic implications of neutrophil-to-lymphocyte ratio in patients with extensive-stage small cell lung cancer receiving chemoimmunotherapy: A multicenter, real-world study.

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are closely related to the prognosis of patients with non-small cell lung cancer, but their effect on extensive-stage small cell lung cancer (ES-SCLC) remains uncertain. METHODS: This retrospective study was conducted in ES-SCLC patients treated with first-line atezolizumab or durvalumab and platinum-etoposide. Clinical data from three hospitals were analyzed. Significant risk factors for survival were identified using descriptive statistics and Cox regression. Homogeneity was assessed using t-tests or nonparametric tests. Kaplan-Meier analysis revealed an association between high NLR level and median PFS and OS. RESULTS: A total of 300 ES-SCLC patients were included in the study. Cox regression analysis revealed that an elevated NLR level after the second treatment cycle (defined as NLRT2) was an independent prognostic factor for survival. Stratifying patients based on median NLRT2 showed significant differences in both PFS (HR: 1.863, 95% CI: 1.62-2.12, p < 0.001) and OS (HR: 2.581, 95% CI: 2.19-3.04, p < 0.001) between NLR ≥ 1.75 and NLR < 1.75 groups. mPFS and mOS were 8.2 versus 6.1 months and 13.7 versus 9.5 months, respectively. NLR was also associated with treatment efficacy and occurrence of irAEs. Further stratification based on NLR and irAEs showed that in the NLR < 1.75 group, patients with irAEs had prolonged mPFS and mOS. In the NLR ≥ 1.75 group, only mPFS showed a significant difference between patients with and without irAEs. CONCLUSION: NLRT2 and irAEs can predict the prognosis of ES-SCLC patients with first-line ES-SCLC receiving PD-L1 inhibitors combined with chemotherapy.