Wang Zanqin, Xun Wenzhen, Ma Xiangxing, Jiang Sicong, Jin Caijin
Department of Cardiothoracic Surgery, Sanmen People's Hospital Taizhou 317100, Zhejiang, China.
Am J Cancer Res. 2025 Aug 15;15(8):3570-3587. doi: 10.62347/RNYP8960. eCollection 2025.
This retrospective study of 455 stage III/IV non-small cell lung cancer patients treated at Sanmen People's Hospital from January 2022 to January 2025 aimed to identify prognostic factors for short-term mortality and develop a validated nomogram for risk assessment. Patients were divided into training (n = 318) and validation (n = 137) cohorts, with clinical and laboratory variables - age, body mass index, Eastern Cooperative Oncology Group (ECOG) performance status, chronic obstructive pulmonary disease (COPD), C-reactive protein (CRP), interleukin-6 (IL-6), serum albumin (ALB), and lactate dehydrogenase (LDH) - analyzed using Kolmogorov-Smirnov tests for data distribution, and t-tests, Mann-Whitney U tests, and chi-square tests for comparisons. Logistic regression identified CRP ≥ 24.42 mg/L (odds ratio = 6.285, P = 0.002), IL-6 ≥ 28.705 pg/mL (odds ratio = 38.364, P < 0.001), and LDH ≥ 357 U/L (odds ratio = 10.132, P < 0.001) as predictors of increased mortality risk, while ALB ≥ 32.65 g/L (odds ratio = 0.073, P < 0.001) and ECOG score = 0 (odds ratio = 0.214, P = 0.040) were associated with reduced risk. Cox regression confirmed CRP, IL-6, ALB, LDH, and COPD as significant predictors. A nomogram constructed from these factors showed strong performance, with area under the curve values of 0.932, 0.930, and 0.962 for 30-, 60-, and 90-day mortality in the training cohort, and 0.894, 0.916, and 0.925 in the validation cohort, respectively, alongside concordance indices of 0.922 (training) and 0.877 (validation). Decision curve analysis and calibration plots confirmed robust clinical applicability and prognostic precision, establishing the nomogram as a reliable tool for personalized risk stratification in advanced lung cancer.
这项回顾性研究对2022年1月至2025年1月在三门县人民医院接受治疗的455例III/IV期非小细胞肺癌患者进行，旨在确定短期死亡率的预后因素，并开发一种经过验证的列线图用于风险评估。患者被分为训练队列（n = 318）和验证队列（n = 137），对临床和实验室变量——年龄、体重指数、东部肿瘤协作组（ECOG）体能状态、慢性阻塞性肺疾病（COPD）、C反应蛋白（CRP）、白细胞介素-6（IL-6）、血清白蛋白（ALB）和乳酸脱氢酶（LDH）——进行分析，使用柯尔莫哥洛夫-斯米尔诺夫检验分析数据分布，使用t检验、曼-惠特尼U检验和卡方检验进行比较。逻辑回归确定CRP≥24.42 mg/L（比值比 = 6.285，P = 0.002）、IL-6≥28.705 pg/mL（比值比 = 38.364，P < 0.001）和LDH≥357 U/L（比值比 = 10.132，P < 0.001）是死亡风险增加的预测因素，而ALB≥32.65 g/L（比值比 = 0.073，P < 0.001）和ECOG评分 = 0（比值比 = 0.214，P = 0.040）与风险降低相关。Cox回归证实CRP、IL-6、ALB、LDH和COPD是显著的预测因素。根据这些因素构建的列线图表现出色，训练队列中30天、60天和90天死亡率的曲线下面积值分别为0.932、0.930和0.962，验证队列中分别为0.894、0.916和0.925，同时一致性指数分别为0.922（训练）和0.877（验证）。决策曲线分析和校准图证实了强大的临床适用性和预后准确性，确立了该列线图作为晚期肺癌个性化风险分层的可靠工具。
