基于肝功能试验指标的列线图用于预测接受 PD-1 抑制剂治疗的鼻咽癌患者的生存情况。

Nomogram Based on Liver Function Test Indicators for Survival Prediction in Nasopharyngeal Carcinoma Patients Receiving PD-1 Inhibitor Therapy.

机构信息

Department of Clinical Laboratory, The First People's Hospital of Zhaoqing, Zhaoqing 526060, China.

Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510060, China.

出版信息

Curr Oncol. 2023 Jul 26;30(8):7189-7202. doi: 10.3390/curroncol30080521.

DOI:10.3390/curroncol30080521

PMID:37623002

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10453561/

Abstract

PURPOSE

The aim of this study was to investigate the prognostic significance of PD-1 inhibitor therapy in nasopharyngeal carcinoma (NPC) and to develop a nomogram to estimate individual risks.

METHODS

We retrospectively analyzed 162 NPC patients who were administered the PD-1 inhibitor combined with radiotherapy and chemotherapy at the Sun Yat-Sen University Cancer Center. In total, 108 NPC patients were included in the training cohort and 54 NPC patients were included in the validation cohort. Univariate and multivariate Cox survival analyses were performed to determine the prognostic factors for 1-year and 2-year progression-free survival (PFS). In addition, a nomogram model was constructed to predict the survival probability of PFS. A consistency index (C-index), a decision curve, a clinical impact curve, and a standard curve were used to measure predictive accuracy, the clinical net benefit, and the consistency of prognostic factors.

RESULTS

Univariate and multivariate analyses indicated that the metastasis stage, the levels of ALT, the AST/ALT ratio, and the LDH were independent risk factors associated with the prognosis of PD-1 inhibitor therapy. A nomogram based on these four indicators was constructed and the Kaplan-Meier survival analysis showed that patients with a higher total score have a shorter PFS. The C-index of this model was 0.732 in the training cohort and 0.847 in the validation cohort, which are higher than those for the TNM stages (training cohort: 0.617; validation cohort: 0.727; <0.05). Decision Curve Analysis (DCA), Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI) showed that our model has better prediction accuracy than TNM staging.

CONCLUSIONS

Predicting PFS in NPC patients based on liver function-related indicators before PD-1 treatment may help clinicians predict the efficacy of PD-1 treatment in these patients.

摘要

目的

本研究旨在探讨 PD-1 抑制剂治疗鼻咽癌（NPC）的预后意义，并构建列线图以评估个体风险。

方法

我们回顾性分析了中山大学肿瘤防治中心接受 PD-1 抑制剂联合放化疗的 162 例 NPC 患者。其中 108 例 NPC 患者纳入训练队列，54 例 NPC 患者纳入验证队列。采用单因素和多因素 Cox 生存分析确定 1 年和 2 年无进展生存（PFS）的预后因素。此外，构建了列线图模型以预测 PFS 的生存概率。一致性指数（C-index）、决策曲线、临床影响曲线和标准曲线用于衡量预测准确性、临床净获益和预后因素的一致性。

结果

单因素和多因素分析表明，转移分期、ALT 水平、AST/ALT 比值和 LDH 是与 PD-1 抑制剂治疗预后相关的独立危险因素。基于这四个指标构建了一个列线图，Kaplan-Meier 生存分析显示总分较高的患者 PFS 较短。该模型在训练队列中的 C-index 为 0.732，在验证队列中的 C-index 为 0.847，均高于 TNM 分期（训练队列：0.617；验证队列：0.727；<0.05）。决策曲线分析（DCA）、净重新分类改善（NRI）和综合判别改善（IDI）表明，我们的模型比 TNM 分期具有更好的预测准确性。