免疫抑制剂治疗KRAS突变晚期非小细胞肺癌患者生存预测模型的构建及验证  

Construction and validation of a survival prediction model for KRAS-mutant advanced non-small cell lung cancer patients treated with immunosuppressants1

作　　者：薛艳峰[1] 郑康[2] Xue Yanfeng;Zheng Kang(Department of Special Medical Services,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Department of Thoracic Surgery,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院特需医疗部,太原030001 [2]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院胸外科,太原030001

出　　处：《肿瘤研究与临床》2024年第10期747-751,共5页Cancer Research and Clinic

摘　　要：目的构建并初步评价免疫抑制剂治疗KRAS突变晚期非小细胞肺癌(NSCLC)患者生存预测模型。方法回顾性队列研究。选取2017年5月至2020年5月山西省肿瘤医院收治的87例接受免疫抑制剂治疗的KRAS突变晚期NSCLC患者,随访至2023年5月。绘制Kaplan-Meier总生存曲线。根据末次随访时生存情况将患者分为生存组、死亡组,分别有31、56例,比较两组临床资料。采用Cox比例风险模型筛选患者死亡的危险因素,基于上述危险因素构建该类患者生存的Cox回归预测模型。以末次随访时生存情况为金标准,绘制该预测模型预测免疫抑制剂治疗的KRAS突变晚期NSCLC患者生存的受试者工作特征(ROC)曲线。结果87例患者中,男性57例(65.5%),女性30例(34.5%),年龄(62±8)岁。患者中位总生存时间18.5个月(95%CI:7.5~37.5个月),3年累积生存率为35.63%(31/87)。与生存组比较,死亡组美国东部肿瘤协作组体能状态(ECOG-PS)评分、癌胚抗原(CEA)、红细胞分布宽度(RDW)、纤维蛋白原(FIB)、D-二聚体(D-D)、乳酸脱氢酶(LDH)、中性粒细胞与淋巴细胞比值(NLR)均高,差异均有统计学意义(均P<0.05)。Cox回归分析结果显示,ECOG-PS评分升高(HR=1.925,95%CI:1.745~2.515,P<0.001)、RDW升高(HR=2.012,95%CI:1.820~2.619,P<0.001)、FIB升高(HR=2.060,95%CI:1.908~2.678,P=0.009)、D-D升高(HR=2.112,95%CI:1.885~2.791,P=0.012)、LDH升高(HR=2.104,95%CI:1.901~2.643,P<0.001)、NLR升高(HR=1.998,95%CI:1.764~2.580,P<0.001)均是免疫抑制剂治疗的KRAS突变晚期NSCLC患者死亡的独立危险因素。基于上述危险因素构建Cox回归预测模型:预后指数(PI)=-10.342+0.582×ECOG-PS评分+0.605×RDW+0.610×FIB+0.599×D-D+0.612×LDH+0.618×NLR。ROC曲线分析显示,该模型预测该类患者生存的曲线下面积为0.885,最佳临界值为1.252,对应的灵敏度、准确度、阳性预测值分别为90.50%、87.09%、84.32%。结论ECOG-PS评分、RDW、FIB、D-D、LDH、NLR与免疫抑制剂治疗的KRAS�Objective To construct and preliminary evaluate a survival prediction model for immunosuppressant treatment of advanced non-small cell lung cancer(NSCLC)patients with KRAS mutations.Methods A retrospective cohort study was conducted.Eighty-seven KRAS-mutant advanced NSCLC patients treated with immunosuppressants who were admitted to Shanxi Province Cancer Hospital from May 2017 to May 2020 were selected and followed up until May 2023.Kaplan-Meier overall survival curves were plotted.The patients were categorized into survival and death groups based on survival status at the final follow-up,with 31 and 56 cases in each group respectively,and the clinical data were compared between the two groups.Cox proportional hazards model was used to screen the risk factors affecting the death of patients,and a Cox regression prediction model for the survival of such patients was constructed based on the above risk factors.Using survival status at the final follow-up as the gold standard,receiver operating characteristic(ROC)curves for this predictive model to predict survival in immunosuppressant-treated KRAS-mutant advanced NSCLC patients were plotted.Results Of the 87 patients,57(65.5%)were male and 30(34.5%)were female,aged(62±8)years.Patients had a median overall survival time of 18.5 months(95%CI:7.5-37.5 months)and a 3-year cumulative survival rate of 35.63%(31/87).Compared with the survival group,the Eastern Cooperative Oncology Group physical status(ECOG-PS)score,carcinoembryonic antigen(CEA),red blood cell distribution width(RDW),fibrinogen(FIB),D-dimer(D-D),lactate dehydrogenase(LDH),and neutrophil-to-lymphocyte ratio(NLR)in the death group were higher,and the differences were statistically significant(all P<0.05).Cox regression analysis showed elevated ECOG-PS score(HR=1.925,95%CI:1.745-2.515,P<0.001),elevated RDW(HR=2.012,95%CI:1.820-2.619,P<0.001),elevated FIB(HR=2.060,95%CI:1.908-2.678,P=0.009),elevated D-D(HR=2.112,95%CI:1.885-2.791,P=0.012),elevated LDH(HR=2.104,95%CI:1.901-2.643,P<0.001),elevated NLR(HR=1.99

关 键 词：癌 非小细胞肺 基因 ras 突变 免疫抑制剂 预后 

分 类 号：R734.2[医药卫生—肿瘤]