Liu Weiwei, Guo Yusheng, Mo Peng, Lou Jie, Gong Bingxin, Fu Xiaona, Li Yi, Zhang Kailu, Ren Yi, Jiang Shanshan, Sun Peng, Li Junping, Wang Yong, Yang Lian
Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Key Laboratory of Molecular Imaging, Wuhan, China.
Transl Lung Cancer Res. 2025 May 30;14(5):1582-1595. doi: 10.21037/tlcr-2024-1125. Epub 2025 May 28.
Changes in bone mineral density (BMD) are recognized as an independent predictor of survival in a variety of diseases. However, the prognostic value of BMD in small cell lung cancer (SCLC) patients treated with immune checkpoint inhibitors (ICIs) is not well understood. This study aimed to explore the prognostic ability of change in bone mineral density (ΔBMD) on the survival of SCLC patients receiving ICIs.
A total of 300 SCLC patients receiving ICIs from three hospitals were enrolled and underwent non-enhanced thoracic computed tomography (CT) before and after treatment. Overall survival (OS) and progression-free survival (PFS) were analyzed using Cox regression models and Kaplan-Meier survival curves. A nomogram model based on independent prognostic factors was developed using multivariate Cox proportional hazards analysis. The predictive efficacy and clinical benefit of the nomogram were evaluated using the time-dependent area under the receiver operating characteristic (ROC) curve and calibration curves.
Lower ΔBMD was associated with shorter PFS and OS. ΔBMD was identified as an independent prognostic factor affecting OS (risk ratios =0.461; P<0.001). The established nomogram resulted in the area under the ROC curve for OS at 9, 12, and 18 months of 0.743, 0.782, and 0.781, respectively. The C-index was 0.701 [95% confidence interval (CI): 0.663-0.739], and the calibration curves confirmed that predictions aligned well with actual observations.
Lower ΔBMD is correlated with poorer clinical outcomes in SCLC patients undergoing treatment with ICIs.
骨密度（BMD）变化被认为是多种疾病生存的独立预测指标。然而，免疫检查点抑制剂（ICI）治疗的小细胞肺癌（SCLC）患者中BMD的预后价值尚不清楚。本研究旨在探讨骨密度变化（ΔBMD）对接受ICI治疗的SCLC患者生存的预后能力。
共纳入来自三家医院的300例接受ICI治疗的SCLC患者，治疗前后均进行胸部非增强计算机断层扫描（CT）。采用Cox回归模型和Kaplan-Meier生存曲线分析总生存期（OS）和无进展生存期（PFS）。使用多变量Cox比例风险分析建立基于独立预后因素的列线图模型。使用受试者操作特征（ROC）曲线下的时间依赖性面积和校准曲线评估列线图的预测效能和临床获益。
较低的ΔBMD与较短的PFS和OS相关。ΔBMD被确定为影响OS的独立预后因素（风险比=0.461；P<0.001）。建立的列线图在9个月、12个月和18个月时OS的ROC曲线下面积分别为0.743、0.782和0.781。C指数为0.701[95%置信区间（CI）：0.663-0.739]，校准曲线证实预测与实际观察结果吻合良好。
接受ICI治疗的SCLC患者中，较低的ΔBMD与较差的临床结局相关。
