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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1487078

A comprehensive nomogram for assessing the prognosis of non-small cell lung cancer patients receiving immunotherapy: A prospective cohort study in China

Provisionally accepted
Hongmei Li Hongmei Li 1Yuliang Yuan Yuliang Yuan 1Qianjie Xu Qianjie Xu 1Guangzhong Liang Guangzhong Liang 1Zuhai Hu Zuhai Hu 2Xiaosheng Li Xiaosheng Li 1Wei Zhang Wei Zhang 1Haike Lei Haike Lei 1*
  • 1 Cancer Hospital, Chongqing University, Chongqing, China
  • 2 Chongqing Medical University, Chongqing, China

The final, formatted version of the article will be published soon.

    Objective: In China, lung cancer ranks first in both incidence and mortality among all malignant tumors. Non-small cell lung cancer (NSCLC) constitutes the vast majority of cases, accounting for 80% to 85% of cases. Immune checkpoint inhibitors (ICIs), either as monotherapies or combined with other treatments, have become the standard first-line therapy for NSCLC patients. This study aimed to establish a nomogram model for NSCLC patients receiving immunotherapy incorporating demographic information, clinical characteristics, and laboratory indicators. Methods: From January 1, 2020, to December 31, 2021, a prospective longitudinal cohort study involving 1321 patients with NSCLC undergoing immunotherapy was conducted at Chongqing University Cancer Hospital. Clinical and pathological characteristics, as well as follow-up data, were collected and analyzed. To explore prognostic factors affecting overall survival (OS), a Cox regression model was used to test the significance of various variables. Independent prognostic indicators were identified through multivariate analysis and then used to construct a nomogram prediction model. To validate the accuracy and practicality of this model, the concordance index (Cindex), area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were used to assess the predictive performance of the nomogram. Result: In the final model, 11 variables from the training cohort were identified as independent risk factors for patients with NSCLC: age, KPS score, BMI, diabetes, targeted therapy, Hb, WBC, LDH, CRP, PLR, and LMR. The C-index for OS in the training cohort was 0.717 (95% CI, 0.689-0.745) and 0.704 (95% CI, 0.660-0.750) in the validation cohort. Calibration curves for survival probability showed good concordance between the nomogram predictions and actual observations. The AUCs for 1-year, 2-year, and 3-year OS in the training cohort were 0.724, 0.764, and 0.79, respectively, and 0.725, 0.736, and 0.818 in the validation cohort. DCA demonstrated that the nomogram model had a greater overall net benefit. Conclusion: A prognostic model for OS in NSCLC patients receiving immunotherapy was established, providing a simple and reliable tool for predicting patient survival (https://icisnsclc.shinyapps.io/DynNomapp/). This model offers valuable guidance for clinicians in making treatment decisions and recommendations.

    Keywords: NSCLC, PD-1/PD-L1, ICIS, nomogram, prognosis

    Received: 27 Aug 2024; Accepted: 31 Oct 2024.

    Copyright: © 2024 Li, Yuan, Xu, Liang, Hu, Li, Zhang and Lei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Haike Lei, Cancer Hospital, Chongqing University, Chongqing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.