Using inflammatory indexes and clinical parameters to predict radiation esophagitis in patients with small-cell lung cancer undergoing chemoradiotherapy

Abstract

ObjectiveRadiation esophagitis (RE) is a common adverse effect in small cell lung cancer (SCLC) patients undergoing thoracic radiotherapy. We aim to develop a novel nomogram to predict the acute severe RE (grade≥2) receiving chemoradiation in SCLC patients.Materials and methodsthe risk factors were analyzed by logistic regression, and a nomogram was constructed based on multivariate analysis results. The clinical value of the model was evaluated using the area under the receiver operating curve (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA). The correlations of inflammation indexes were assessed using Spearman correlation analysis.ResultsEighty-four of 187 patients (44.9%) developed grade ≥2 RE. Univariate analysis indicated that concurrent chemoradiotherapy (CCRT, p < 0.001), chemotherapy cycle (p = 0.097), system inflammation response index (SIRI, p = 0.048), prognostic-nutrition index (PNI, p = 0.073), platelets-lymphocyte radio (PLR, p = 0.026), platelets-albumin ratio (PAR, p = 0.029) were potential predictors of RE. In multivariate analysis, CCRT [p < 0.001; OR, 3.380; 95% CI, 1.767-6.465], SIRI (p = 0.047; OR, 0.436; 95% CI, 0.192-0.989), and PAR (p = 0.036; OR, 2.907; 95% CI, 1.071-7.891) were independent predictors of grade ≥2 RE. The AUC of nomogram was 0.702 (95% CI, 0.626-0.778), which was greater than each independent predictor (CCRT: 0.645; SIRI: 0.558; PAR: 0.559). Calibration curves showed high coherence between the predicted and actual observation RE, and DCA displayed satisfactory clinical utility.ConclusionIn this study, CCRT, SIRI, and PAR were independent predictors for RE (grade ≥2) in patients with SCLC receiving chemoradiotherapy. We developed and validated a predictive model through these factors. The developed nomogram with superior prediction ability can be used as a quantitative model to predict RE.

Clinical impact of first‐line PD‐1 or PD‐L1 inhibitors combined with chemotherapy in extensive‐stage small cell lung cancer patients: A real‐world multicenter propensity score‐matched study

“…At several stages of tumor growth, inflammatory responses are crucial 35 . Some indexes related to inflammation and nutritional status, such as the NLR, SIRI, and LIPI, have been identified as valuable prognostic factors for some cancers 13–16 . However, it remains unclear if these markers still have a similar effect in cases with ES‐SCLC.…”

“…Patient information before treatment, including age, sex, smoking history, Eastern Cooperative Oncology Group (ECOG) performance status (PS), baseline information of tumor, count of leukocyte, neutrophil, lymphocyte, monocyte, and platelet, lactate dehydrogenase (LDH), serum albumin, tumor markers, and weight and height, was collected. Several indexes have been used to assess inflammation and nutritional status in our study, including the following: neutrophil–lymphocyte ratio (NLR) = neutrophil/lymphocyte; platelet–lymphocyte ratio (PLR) = platelet/lymphocyte; lymphocyte–monocyte ratio (LMR) = lymphocyte/monocyte; systemic immune‐inflammation index (SII) = platelet × NLR 16 ; SIRI = neutrophil × monocyte/lymphocyte 16 ; PNI = serum albumin (g/L) + 5 × total lymphocyte count (10 9 /L) 13 ; body mass index (BMI) = weight(kg)/height(m) 2 ; and advanced lung cancer inflammation index (ALI) = BMI × (serum albumin/NLR) 14 . The baseline LDH level and the dNLR (derived neutrophil‐lymphocyte ratio: neutrophil count/[white blood cell count–neutrophil count]) level were used to calculate the lung immune prognostic index (LIPI) 15 .…”

“…Systemic inflammatory responses have been confirmed to be associated with the development and spread of malignancies 12 . As a result, some inflammatory and nutritional markers have an intriguing role in clinical practice as prognostic factors, for example, systemic inflammation response index (SIRI) and prognostic nutrition index (PNI) 13–16 . However, the predictive value of these markers for ES‐SCLC cases who received chemotherapy with ICIs remains uncertain.…”

Enhanced prediction of postoperative radiotherapy‐induced esophagitis in non‐small cell lung cancer: Dosiomic model development in a real‐world cohort and validation in the PORT‐C randomized controlled trial

“…First, the limited sample size could have affected the performance of the prediction model. Second, this study did not include clinical factors associated with RE, such as age and chemotherapy 30 . Third, our study's occurrence rate of symptomatic RE was only 11.6%, which may have affected the prediction model.…”

Prognostic value of pretreatment modified Glasgow Prognostic Score in small cell lung cancer: A meta-analysis

“…[1] It is characterized by high degree of malignancy, rapid progression and metastasis, and poor prognosis. [2][3][4] The tumor stage of SCLC patients is usually evaluated according to the Veterans Administration Lung Study Group staging system which includes limited stage SCLC and extensive stage SCLC and about 70% of the patients are already in the extensive stage at the time of diagnosis. [2,5] In the past decades, there has been no significant progress in the targeted therapy and immunotherapy of SCLC and most patients could only be treated by traditional chemotherapy and radiation.…”