Analysis of influencing factors on prognosis for survival and construction of prediction model in patients with advanced non-small-cell lung cancer treated with immune checkpoint inhibitors
10.3760/cma.j.cn114015-20230627-00472
- VernacularTitle:免疫检查点抑制剂治疗晚期非小细胞肺癌患者生存预后的影响因素分析及预测模型构建
- Author:
Shixin MA
1
;
Fei LI
;
Chaoyu WEI
;
Cailong JIN
;
Lunqing WANG
Author Information
1. 大连医科大学研究生院，大连 116044
- Publication Type:Journal Article
- Keywords:
Immune checkpoint inhibitors;
Prognosis;
Carcinoma, non-small-cell lung;
Immune-related adverse events;
Survival analysis;
Nomogram;
Prediction model
- From:
Adverse Drug Reactions Journal
2023;25(12):724-731
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the influencing factors on the prognosis for survival in patients with advanced non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) and to construct a nomogram for predicting the prognosis for survival.Methods:The research was designed as a retrospective study. The subjects were selected from advanced NSCLC patients who visited Qingdao Municipal Hospital from January 2019 to December 2021 and received ICIs. The clinical data of patients was extracted through the hospital diagnosis and treatment system. A Cox proportional risk model was used to analyze the factors affecting the prognosis for survival in patients. Patients were randomly divided into the modeling group and validation group according to a ratio of 7∶3. Using R4.2.1 software, a nomogram was built, and its prediction performance was verified based on the bootstrap repeated sampling method. Patients were divided into low- and high-risk groups according to the nomogram. The overall survival (OS) of patients was described through Kaplan-Meier curve, and the difference between the 2 groups was compared using the log-rank test.Results:A total of 161 patients with advanced NSCLC were included in the analysis, with an age of (65±8.7) years. Among the 161 patients, 127 were male, 113 had a pathological classification of NSCLC as adenocarcinoma, 86 had an Eastern Coperative Oncology Group Performance Status (ECOG PS) score ≥2, and 113 had ICI combined with other treatments. By December 2022, 81 patients (50.3%) had experienced immune-related adverse events (irAEs), of which 14 had grade 3 or 4 irAEs and 15 had irAEs in multiple systems. Eighty-six patients died. Cox regression analysis showed that advanced lung cancer inflammation index (ALI)≥29.8 [hazard ratio ( HR)=0.48, 95% confidence interval ( CI): 0.28-0.85, P=0.011], ECOG PS score ≥2 ( HR=2.17, 95% CI: 1.21-3.90, P=0.009), and having irAEs ( HR=0.40, 95% CI: 0.21-0.76, P=0.005) were prognostic factors for survival in patients with advanced NSCLC treated by ICIs. The nomogram was established based on factors of age, gender, ECOG PS score, irAEs, and ALI, and the total score of each patient was calculated. The patients were divided into the low-risk group (126 cases) and high-risk group (35 cases) according to the optimal cut-off value (183.82) of the receiver operator characteristic curve. The Kaplan-Meier curve and log-rank analysis showed that there was a statistically significant difference in OS between the 2 groups ( P<0.00 1). Conclusion:ALI, ECOG PS score, and irAEs are independent factors affecting the prognosis for survival in advanced NSCLC patients receiving ICIs, and the nomogram constructed based on multiple biological indicators can effectively predict patient prognosis for survival.
