Diker Omer, Olgun Polat, Balyemez Ugurcan, Sigit Ikiz Sinem
Medical Oncology, Near East University Hospital, Nicosia, CYP.
Radiology, Near East University Hospital, Nicosia, CYP.
Cureus. 2023 Jan 1;15(1):e33234. doi: 10.7759/cureus.33234. eCollection 2023 Jan.
Immune checkpoint inhibitors (ICIs) have become the standard of care for the treatment of patients with driver mutation absent advanced non-small cell lung cancer (NSCLC). The present study aimed to develop a reliable, reproducible, and practical scoring system to prognosticate and predict response to ICI response in patients with advanced NSCLC.
All patients who were diagnosed as having unresectable/advanced stage NSCLC and were treated with at least one cycle of ICIs at the Medical Oncology Departments of Dr. Burhan Nalbantoğlu State Hospital (Nicosia, Cyprus) and Near East University Hospital (Nicosia, Cyprus) were included in the study. The association between variables and OS was evaluated using a Cox proportional hazards regression model. Variables with a P-value less than 0.05 in the univariate analysis were included in the multivariate model. A prognostic scoring system was developed. Survival estimates were calculated using the Kaplan-Meier method. The value of the Concordance index (C-index) and the area under the curve (AUC) was used to evaluate the discriminative ability of scoring systems.
One hundred fifty consecutive patients with unresectable/metastatic NSCLC who received PD-1 inhibitors between March 2017 and November 2022 were included. In the multivariate Cox regression model, serum lactate dehydrogenase (LDH), C-reactive protein (CRP) levels, and Eastern Cooperative Oncology Group Performance Status (ECOG PS) were significantly associated with OS. We generated a new score using CRP ³1.0 mg/dL, ECOG PS ³2, and LDH level >ULN. Relative weight was based on the HRs of multivariate analyses (CRP ³1.0 mg/dL 2 points, ECOG PS ³2 2.5 points, and LDH level >ULN 1.5 points). The cohort was divided into three risk groups based on the sum of factors present: 0-2.5 (good risk), 3.5-4.5 (intermediate risk), or 6 (poor risk). The median OS was 18.9, 7.4, and 2.9 months for good, intermediate, and poor risk categories, respectively (log-rank test, p<0.001). The Harrell C-index of CEL to predict OS and PFS was 0.73 and 0.69, respectively, indicating significant predictability. The AUC of the scoring index for predicting the responses was 0.765 (95% CI: 0.685-0.845).
The CEL score is a promising prognostic and predictive index consisting of serum CRP levels (C), ECOG PS (E), and serum LDH levels (L). This represents another step forward in the treatment of patients with advanced NSCLC.
免疫检查点抑制剂（ICIs）已成为驱动基因突变缺失的晚期非小细胞肺癌（NSCLC）患者治疗的标准方案。本研究旨在开发一种可靠、可重复且实用的评分系统，用于预测晚期NSCLC患者对ICI治疗的反应及预后。
纳入所有在布尔汉·纳尔班托卢博士国家医院（塞浦路斯尼科西亚）和近东大学医院（塞浦路斯尼科西亚）肿瘤内科被诊断为不可切除/晚期NSCLC且接受至少一个周期ICI治疗的患者。使用Cox比例风险回归模型评估变量与总生存期（OS）之间的关联。单因素分析中P值小于0.05的变量纳入多因素模型。开发了一种预后评分系统。使用Kaplan-Meier方法计算生存估计值。一致性指数（C指数）和曲线下面积（AUC）用于评估评分系统的判别能力。
纳入了2017年3月至2022年11月期间连续150例接受PD-1抑制剂治疗的不可切除/转移性NSCLC患者。在多因素Cox回归模型中，血清乳酸脱氢酶（LDH）、C反应蛋白（CRP）水平和东部肿瘤协作组体能状态（ECOG PS）与OS显著相关。我们使用CRP≥1.0 mg/dL、ECOG PS≥2和LDH水平>正常上限（ULN）生成了一个新的评分。相对权重基于多因素分析的风险比（HRs）（CRP≥1.0 mg/dL为2分，ECOG PS≥2为2.5分，LDH水平>ULN为1.5分）。根据存在的因素总和将队列分为三个风险组：0 - 2.5（低风险）、3.5 - 4.5（中风险）或6（高风险）。低、中、高风险组的中位OS分别为18.9、7.4和2.9个月（对数秩检验，p<0.001）。CEL预测OS和无进展生存期（PFS）的Harrell C指数分别为0.73和0.69，表明具有显著的预测性。预测反应的评分指数的AUC为0.765（95%CI：0.685 - 0.845）。
CEL评分是一种有前景的预后和预测指标，由血清CRP水平（C）、ECOG PS（E）和血清LDH水平（L）组成。这代表了晚期NSCLC患者治疗向前迈出的又一步。
