Development of a Clinically Oriented Model to Predict Antitumor Effects after PD-1/PD-L1 Inhibitor Therapy

Abstract

Immune checkpoint inhibitors (ICI) have created an advanced shift in the treatment of lung cancer (LC), but the existing biomarkers were not in clinical and widespread use. The purpose of this study was to develop a new nomogram with immune factors used for monitoring the response to ICI therapy. LC patients with PD-1/PD-L1 inhibitors treatment were included in this analysis. The immune biomarkers and clinicopathological characteristic values at baseline were used to estimate the tumor response. The nomogram was based on the factors that were determined by univariate and multivariate Cox hazard analysis. For internal validation, bootstrapping with 1000 resamples was used. The concordance index ( C -index) and calibration curve were used to determine the predictive accuracy and discriminative ability of the nomogram. Overall survival (OS) was estimated using the Kaplan-Meier method. Patients with lung metastasis ( P = 0.010 ), higher baseline neutrophil-lymphocyte ratio (NLR) level ( P < 0.001 ), lower baseline lymphocyte-monocyte (LMR) ( P = 0.019 ), and lower CD3+CD8+ T cell count ( P = 0.009 ) were significantly related to the tumor response. The above biomarkers were contained into the nomogram. The calibration plot for the probability of OS showed an optimal agreement between the actual observation and prediction by nomogram at 3 or 5 years after therapy. The C -index of nomogram for OS prediction was 0.804 (95% CI: 0.739-0.869). Decision curve analysis demonstrated that the nomogram was clinically useful. Moreover, patients were divided into two distinct risk groups for OS by the nomogram: low-risk group (OS: 17.27 months, 95% CI: 14.75-19.78) and high-risk group (OS: 6.11 months, 95% CI: 3.57-8.65), respectively. A nomogram constructed with lung metastasis baseline NLR, LMR, and CD3+CD8+ T cell count could be used to monitor and predict clinical benefit and prognosis in lung cancer patients within ICI therapy.

Development and validation of a novel nomogram for predicting overall survival of lung cancer patients treated with immune checkpoint inhibitors: A retrospective cohort study in China

“…Prior studies have indeed utilized nomograms to predict patient outcomes in the context of lung cancer immunotherapy (He et al 2022…”

“…Previous studies such as the one by He B.X. and colleagues, have largely focused on imaging-based scores using advanced techniques like deep learning(He et al 2022). While these are valuable, they often lack consideration of certain clinical or biological factors that our study addresses.…”

“…Other studies may be limited by focusing only on speci c types of ICIs, such as PD-1 inhibitors, or only including foreign drugs without considering those available and commonly used in speci c regions like China. Thus, while nomograms have been used in the context of lung cancer immunotherapy, our approach adds a more comprehensive and regionally relevant model to this existing body of work(Yuan et al 2021;Wang et al 2022;Li et al 2022).…”