中国临床医学2025，Vol.32Issue(4)：561-567,7.DOI:10.12025/j.issn.1008-6358.2025.20250469
多学科参与的ICI相关心肌炎风险评估量表的建立及验证
Development and validation of a multidisciplinary risk assessment scale for immune checkpoint inhibitor-associated myocarditis
摘要
Abstract
Objective To develop a risk assessment scale for immune checkpoint inhibitor(ICI)-associated myocarditis based on multidisciplinary collaboration,and to evaluate its diagnostic performance.Methods Based on multidisciplinary cooperation,integrating clinical experience from oncology and cardiology,literature data,and patient conditions,a risk assessment scale for ICI-associated myocarditis was developed.A total of 101 patients with malignancies who received immunotherapy at Zhongshan Hospital,Fudan University,from October 2020 to October 2024 were included as the validation cohort.Patients were stratified into low-risk(0-1 point),medium-risk(2-4 points),and high-risk(≥5 points)groups based on their scale scores.The association between pretictive risk stratifications and actual assessment results was assessed using the Cox proportional hazards regression model.The predictive value of the scale for ICI-associated myocarditis was evaluated using receiver operating characteristic(ROC)curve.Agreement between the scale scores and actual assessment results was assessed using Cohen's Kappa coefficient.Results Based on the scale pretictive results,28(27.7%),8(7.9%),65(64.4%)patients were at low risk,medium risk,and high risk for ICI-related myocarditis,respectively;however,46(45.5%),8(7.9%),47(46.5%)were at low risk,medium risk,and high risk actually.Kaplan-Meier survival analysis showed that the cumulative incidence of ICI-related myocarditis in the high-risk group was significantly higher than that in the medium-and low-risk groups(P＜0.05).In the multivariable-adjusted Cox proportional hazards model,the ICI-related myocarditis risk in high-risk group was about 4 times that in the low-risk group.ROC curve analysis demonstrated that the average area under the curve(AUC)for predicting ICI-related myocarditis was 0.81,with an accuracy of 0.74.The Cohen's Kappa coefficient was 0.55,indicating moderate agreement.In the actual high-risk group,no patient was predicted to be at low risk;in the actual low-risk group,16 patients were predicted to be at high risk.Conclusions This risk assessment scale for ICI-associated myocarditis shows high predictive performance.It provides oncologists with a simple yet effective multidisciplinary diagnostic reference tool,potentially enhancing early identification of ICI-associated myocarditis.关键词
免疫检查点抑制剂/心肌炎/风险评估量表/多学科诊断Key words
immune checkpoint inhibitor/myocarditis/risk assessment scale/multidisciplinary diagnosis分类
医药卫生引用本文复制引用
戴亚男,刘媛,许宇辰,蔡青青,王妍,周宇红,程蕾蕾,葛均波..多学科参与的ICI相关心肌炎风险评估量表的建立及验证[J].中国临床医学,2025,32(4):561-567,7.基金项目
国家自然科学基金(82470354,82170359),四大慢病重大专项(2023ZD0502800),中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2024-JKCS-28),上海申康医院发展中心市级医院诊疗技术推广及优化管理技术规范化管理和推广项目(SHDC22023207).Supported by National Natural Science Foundation of China(82470354,82170359),the Major Project on Four Chronic Diseases(2023ZD0502800),Special Fund for Fundamental Research Expenses of Central Public Welfare Scientific Research Institutes,Chinese Academy of Medical Sciences(2024-JKCS-28),and Shanghai Shenkang Hospital Development Center Project on Standardized Management and Promotion of Diagnostic and Therapeutic Techniques in Municipal Hospitals(SHDC22023207). （82470354,82170359）
