{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T12:34:00Z","timestamp":1793622840023,"version":"4.5.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune checkpoint inhibitors (ICIs) have reshaped the treatment landscape of non-small cell lung cancer (NSCLC), but immune-related neuromuscular toxicities remain difficult to anticipate. ICI-associated myasthenia gravis is uncommon, frequently occurs early after treatment initiation, and may overlap with myositis or myocarditis. Clinically accessible blood-based indicators that help identify patients entering this high-risk period remain insufficiently defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluated whether early dynamic changes in serum tumor markers and immune-inflammatory biomarkers could serve as noninvasive indicators of subsequent ICI-associated myasthenia gravis in patients with NSCLC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive patients with NSCLC who received their first ICI-based therapy between 1 January 2018 and 31 January 2025 were retrospectively screened at a single center. Baseline, Day-21, and Day-42 laboratory windows were prespecified before endpoint modeling. Serum tumor markers included carcinoembryonic antigen, cytokeratin 19 fragment antigen 21-1, neuron-specific enolase, squamous cell carcinoma antigen, and carbohydrate antigen 125. Immune-inflammatory biomarkers included neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, C-reactive protein, lactate dehydrogenase, and albumin. The primary endpoint was definite or probable ICI-associated myasthenia gravis occurring within 180 days after first ICI exposure. Landmark models were developed using Firth bias-reduced logistic regression and internally validated by bootstrap resampling. The Day-21 dynamic score used clinically pragmatic thresholds defined before endpoint modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final baseline cohort included 826 patients, of whom 27 developed definite or probable ICI-associated myasthenia gravis within 180 days. The Day-21 landmark cohort included 782 patients and 21 events occurring after Day 21. Compared with non-event patients, patients who later developed ICI-associated myasthenia gravis showed greater Day-21 increases in cytokeratin 19 fragment antigen 21-1, carcinoembryonic antigen, neutrophil-to-lymphocyte ratio, C-reactive protein, and lactate dehydrogenase, together with a larger decline in albumin. A four-component Day-21 dynamic score combining tumor-marker instability, neutrophil-to-lymphocyte ratio activation, C-reactive protein\/lactate dehydrogenase flare, and albumin decline stratified event rates after Day 21 from 1.2% in the low-risk group to 6.7% in the high-risk group. The integrated Day-21 model achieved an apparent area under the receiver operating characteristic curve of 0.759 and an optimism-corrected area under the receiver operating characteristic curve of 0.731, indicating moderate internal discrimination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early dynamic changes in routine serum tumor markers and immune-inflammatory biomarkers were associated with increased risk of ICI-associated myasthenia gravis in patients with NSCLC. The Day-21 integrated biomarker score may help identify patients requiring closer neuromuscular and cardiac toxicity surveillance during the first few weeks of ICI therapy, but external validation is required before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1929526","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:32:16Z","timestamp":1789014736000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dynamic serum tumor-marker and immune-inflammatory biomarker changes for risk stratification of immune checkpoint inhibitor-associated myasthenia gravis in non-small cell lung cancer"],"prefix":"10.3389","volume":"17","author":[{"given":"Pin","family":"Cui","sequence":"first","affiliation":[{"name":"Shenzhen Rapha Biotechnology Incorporate","place":["Shenzhen, Guangdong, 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