Abstract
BackgroundImmune checkpoint inhibitors (ICIs) plus chemotherapy improved the prognosis of patients with non-small cell lung cancer (NSCLC); however, reliable prognostic biomarkers are lacking. We explored factors associated with prognosis and developed a predictive model.MethodsWe retrospectively analyzed 130 consecutive stage IIIA–IVB NSCLC patients treated with ICIs combined with chemotherapy. Cox univariate and multivariate proportional hazards regression analyses were used to identify prognostic factors associated with progression-free survival (PFS). A nomogram was developed based on key factors in the training cohort (n = 86) and evaluated in the validation cohort (n = 44). According to the nomogram-based total point scores, we divided patients into low- and high-risk groups.ResultsIn the training cohort, bone metastases (p = 0.017) and an increased derived neutrophil-to-lymphocyte ratio (p = 0.018) were significantly associated with poor PFS, while smoking (p = 0.007) and programmed death-ligand 1 (PD-L1) ≥50% (p = 0.001) were associated with improved PFS. A nomogram based on these factors was developed to predict PFS at 3, 6, and 12 months. The C-index of the nomogram to predict PFS was 0.725 (95% CI: 0.711–0.739) in the training cohort and 0.688 (95% CI: 0.665–0.711) in the validation cohort. The area under the curve (AUC) exhibited an acceptable discriminative ability, and calibration curves demonstrated a consistency between the actual results and predictions. In the training cohort, the median PFS (mPFS) was 12.3 and 5.7 months in the low- and high-risk groups, respectively (p < 0.001). In the validation cohort, the mPFS was 12.6 and 6.2 months in the low- and high-risk groups, respectively (p = 0.021).ConclusionsA predictive nomogram was developed to help clinicians assess prognosis early for advanced NSCLC patients who received ICI plus chemotherapy.
Highlights
According to Global Cancer Statistics in 2020, lung cancer is the second most commonly diagnosed malignant tumor and remains the leading cause of cancer death in the world [1]
The concordance index (C-index) of the nomogram to predict progression-free survival (PFS) was 0.725 in the training cohort and 0.688 in the validation cohort
According to predictive factors identified in the training cohort, we developed a nomogram to predict the probability of PFS at 3, 6, and 12 months in non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs) plus chemotherapy (Figure 3)
Summary
According to Global Cancer Statistics in 2020, lung cancer is the second most commonly diagnosed malignant tumor and remains the leading cause of cancer death in the world [1]. Considerable successes have been achieved using novel therapeutic strategies, i.e., immune checkpoint inhibitors (ICIs), as first-line and second-line treatments in patients with NSCLC [4, 5]. Nearly 60% of patients with advanced NSCLC do not benefit from ICIs [6]. Remarkable heterogeneity regarding their objective response rate, survival, immunerelated adverse events (irAEs) in individual NSCLC patients, and limits in current biomarkers have driven some studies to look for new prognostic markers or to develop a comprehensive model to optimize patient benefit [7, 8]. Immune checkpoint inhibitors (ICIs) plus chemotherapy improved the prognosis of patients with non-small cell lung cancer (NSCLC); reliable prognostic biomarkers are lacking. We explored factors associated with prognosis and developed a predictive model
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