Efficacy and prognostic factors of first-line bevacizumab plus chemotherapy in elderly patients with advanced driver gene-negative lung adenocarcinoma: A retrospective study

We aimed to evaluate clinical outcomes and identify prognostic indicators in elderly patients with driver gene-negative advanced lung adenocarcinoma treated with first-line bevacizumab-based therapy. Elderly patients (≥65 years) with driver gene-negative advanced lung adenocarcinoma treated between January 2020 and December 2024 were retrospectively included. According to first-line treatment strategies, patients were divided into a chemotherapy-alone group and a bevacizumab plus chemotherapy group. Progression-free survival (PFS) and overall survival (OS) were analyzed using univariate and multivariate Cox regression models. A total of 169 patients were included. In the bevacizumab group, the median OS was 47 months and the median PFS was 24 months. Multivariate analysis showed that prognostic nutritional index (PNI), vascular endothelial growth factor A, carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA-125), and bevacizumab treatment were independent prognostic factors for PFS. Additionally, neutrophil-to-white blood cell ratio (NWR), neutrophil-to-lymphocyte ratio, PNI, vascular endothelial growth factor A, CA-125, and bevacizumab treatment were independently associated with OS. Our findings suggest that bevacizumab combined with chemotherapy is associated with favorable survival outcomes in elderly patients with driver gene-negative advanced lung adenocarcinoma. Inflammation-, nutrition-, and tumor burden-related biomarkers may help predict survival and assist in risk stratification.