PD-L1表达水平联合营养状况评分构建局部晚期或转移性非小细胞肺癌免疫治疗的生存预测模型
Construction of A Survival Prediction Model for Immunotherapy in Locally Advanced or Metastatic Non-Small Cell Lung Cancer Based on PD-L1 Expression Combined with Nutritional Status Score
摘要
Abstract
Objective To analyze the factors affecting the prognosis of patients with locally advanced or metastatic non-small cell lung cancer(NSCLC)undergoing immunotherapy and construct an individualized prognostic nomogram prediction model.Methods A retrospective analysis was conducted on the clinical data of 385 patients with driver gene-negative,locally advanced or metastatic NSCLC who received first-line immune checkpoint inhibitors.Univariate and multivariate Cox regression analyses were used to identify prognostic risk factors,and a prognostic nomogram model was established.The predictive performance of the model was evaluated using the concordance index(C-index),time-dependent receiver operating characteristic(ROC)curves and area under the curve(AUC),and calibration curves.The cutoff value of the nomogram was calculated to stratify patients by risk.Survival curves were calculated by Kaplan-Meier analysis.Results Age(HR=1.775,95％CI:1.265-2.490),degree of differentiation(HR=0.365,95％CI:0.257-0.519),low PD-L1 expression(HR=0.661,95％CI:0.455-0.960),high PD-L1 expression(HR=0.423,95％CI:0.297-0.603),SCC-Ag(HR=1.549,95％CI:1.109-2.163),and CONUT score(HR=2.527,95％CI:1.797-3.554)were independent risk factors affecting overall survival(OS)of patients with NSCLC undergoing immunotherapy.The nomogram prediction model constructed on the basis of these factors had a C-index of 0.767.Time-dependent ROC curves for survival showed that the AUCs for 1-,2-,and 3-year OS were 0.830,0.853,and 0.886,respectively.Calibration curves indicated that the nomogram-predicted survival rates were in good agreement with the actual outcomes.The cutoff value for the study's nomogram prediction model was 136.60 points,and survival curves showed statistically significant differences between different risk groups(P<0.05).Conclusion The nomogram model established in this study can effectively predict the prognosis of patients with driver gene-negative locally advanced or metastatic NSCLC treated with first-line immunosuppressive therapy.It provides a new tool for assessing prognosis and aids clinicians in formulating individualized treatment plans.关键词
非小细胞肺癌/免疫治疗/控制营养状况评分/生存分析/预后预测模型Key words
Non-small cell lung cancer/Immunotherapy/Controlling nutritional status score/Survival analysis/Prognostic prediction model分类
医药卫生引用本文复制引用
李锦华,祁萍,马吉利,吕亚霞,伏彩红,张陇霞,乔慧..PD-L1表达水平联合营养状况评分构建局部晚期或转移性非小细胞肺癌免疫治疗的生存预测模型[J].肿瘤防治研究,2026,53(6):457-466,10.基金项目
Longyuan Youth Innovation and Entrepreneurship Talent Team Project in 2022 from the Organization Department of CPC Gansu Provincial Party Committee(No.2022LQTD24) （No.2022LQTD24）
Lanzhou Science and Technology Bureau 2023 Science and Technology Plan Project(No.2023-4-17) （No.2023-4-17）
Gansu Science and Technology Project(No.24JRRA314) （No.24JRRA314）
Excellent Young Talents Project from Gansu Provincial Department of Health(No.GSWSQN2024-10) （No.GSWSQN2024-10）
The First Hospital of Lanzhou University Hospital Fund(No.ldyyyn2023-2) 中共甘肃省委组织部2022年陇原创新创业人才团队项目(2022LQTD24) （No.ldyyyn2023-2）
兰州市科学技术局2023年科技计划项目(2023-4-17) （2023-4-17）
甘肃省自然科学基金(24JRR-A314) （24JRR-A314）
甘肃省卫生厅优秀青年人才项目(GSWSQN2024-10) （GSWSQN2024-10）
兰州大学第一医院院内基金(ldyyyn2023-2) （ldyyyn2023-2）
