老年非小细胞肺癌患者顺铂化疗敏感性影响因素分析及列线图模型构建  

Analysis of influencing factors of cisplatin chemotherapy sensitivity and construction of nomogram model in elderly patients with non-small cell lung cancer

作　　者：何婷[1] 陈婧婧[1] 李雨玲 HE Ting;CHEN Jingjing;LI Yuling(Department of Respiratory and Critical Care Medicine,Lishui People’s Hospital,Lishui 323000,Zhejiang Province,China)

机构地区：[1]丽水市人民医院呼吸与危重症医学科,浙江丽水323000

出　　处：《药学前沿》2025年第2期284-290,共7页China Pharmacist

基　　金：浙江省医药卫生科技计划项目(2024KY588)。

摘　　要：目的分析老年非小细胞肺癌患者顺铂化疗敏感性影响因素并构建列线图预测模型。方法回顾性分析2018年1月至2024年1月丽水市人民医院收治的老年非小细胞肺癌患者,以实体瘤疗效评价标准1.1作为化疗敏感性评估的“金标准”,将患者分为顺铂敏感组(完全缓解/部分缓解/疾病稳定)和顺铂耐药组(疾病进展或死亡),分析老年肺癌患者顺铂化疗敏感性的独立影响因素,通过R软件构建列线图+预测模型,利用受试者工作特征(ROC)曲线评估该模型的预测价值。结果103例老年非小细胞肺癌患者顺铂敏感61例(59.22%),顺铂耐药42例(40.78%);多因素分析显示,远处转移情况、血红蛋白、白蛋白、淋巴细胞和血小板(HALP)评分、细胞角蛋白19片段(CYFRA21-1)、中性粒细胞淋巴细胞比率(NLR)是老年肺癌患者顺铂化疗敏感性的独立影响因素(P<0.05);联合应用时建立四因子预测模型Ln[P/(1-P)]=2.545+1.318×远处转移-0.294×HALP评分+0.302×CYFRA21.1+1.958×NLR,对模型进行霍斯默-莱梅肖(Hosmer-Lemeshow)拟合优度检验,χ^(2)为1.879,P=0.985>0.05,ROC曲线下面积(即一致性指数)为0.909。结论远处转移情况、HALP评分、CYFRA21-1、NLR与老年非小细胞肺癌患者顺铂化疗敏感性显著相关,基于以上影响因素构建的列线图模型有助于早期识别老年肺癌患者顺铂化疗收益患者。Objective To analyze the influencing factors of cisplatin chemotherapy sensitivity in elderly patients with non-small cell lung cancer and to construct a nomogram prediction model.Methods A retrospective analysis was conducted on elderly patients with non-small cell lung cancer who received treatment in the Lishui People’s Hospital from January 2018 to January 2024.Taking solid tumor efficacy evaluation standard 1.1 as the gold standard for the evaluation of chemotherapy sensitivity,the patients were divided into the cisplatin-sensitive group(complete remission/partial remission/stable disease)and the cisplatin-resistant group(disease progression or death).The independent influencing factors of cisplatin chemotherapy sensitivity in elderly patients with lung cancer were analyzed,and the nomogram and the prediction model was constructed by R software.Additionally,the predictive value of the model was evaluated by drawing receiver operating characteristic(ROC)curve.Results Among 103 elderly patients with non-small cell lung cancer,61 cases(59.22%)were sensitive to cisplatin and 42 cases(40.78%)were resistant to cisplatin.According to the multivariate analysis,the distant metastasis,hemoglobin,albumin,lymphocytes and platelets(HALP)score,cytokeratin 19 fragment(CYFRA21-1)and neutrophil-lymphocyte ratio(NLR)were independent influencing factors of cisplatin chemotherapy sensitivity(P<0.05).In the combined application,a four factor prediction model was established as Ln[P/(1-P)]=2.545+1.318×distant metastasis-0.294×HALP score+0.302×CYFRA21.1+1.958×NLR.Hosmer-Lemeshow goodness-fit test was performed on the model,with χ^(2) of 1.879,P=0.985>0.05,and the area under the ROC curve(the consistency index)of 0.909.Conclusion The distant metastasis,HALP score,CYFRA21-1 and NLR are significantly correlated with the sensitivity of cisplatin chemotherapy in elderly patients with non-small cell lung cancer.The nomogram model based on the above influencing factors is helpful for early identification of patients with cisplatin

关 键 词：老年 非小细胞肺癌 顺铂 化疗敏感性 影响因素 列线图模型 预测效能 

分 类 号：R734.2[医药卫生—肿瘤]