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    C-PLAN指数对一线免疫治疗晚期NSCLC患者生存状况的预测价值

    Prognostic value of C-PLAN index in predicting the survival of advanced NSCLC patients after first-line immunotherapy

    • 摘要: 目的 探讨C反应蛋白(CRP)、体力状况评分(PS)、乳酸脱氢酶(LDH)、白蛋白(ALB)及衍生中性粒细胞与淋巴细胞比值(dNLR)联合指数(C-PLAN)对晚期非小细胞肺癌(NSCLC)免疫治疗患者生存状况的预测价值。方法 选取2019年1月—2024年1月于徐州医科大学附属医院接受免疫治疗的411例初诊晚期NSCLC患者,收集临床资料。按照7∶3的比例将患者随机分为训练集和验证集,计算患者接受治疗前7 d内及治疗后第6周的C-PLAN指数。随访统计患者的总生存期(OS)和无进展生存期(PFS)。比较训练集和验证集患者的临床病理特征,并分析C-PLAN指数与晚期NSCLC患者治疗疗效的关系。以发生进展或死亡为结局变量,绘制Kaplan-Meier生存曲线,使用Log-rank检验比较不同分组的生存差异。对训练集数据进行单因素分析和多因素Cox回归分析,构建预测模型,绘制操作者工作特征(ROC)曲线和校准曲线评估模型的预测效能。结果 训练集患者288例,其中ORR为30.6%,DCR为41.0%;验证集患者123例,其中ORR为34.1%,DCR为44.7%。不论治疗前还是治疗后第6周,C-PLAN低水平组和高水平组的组间ORR和DCR比较,差异均有统计学意义(P<0.05),C-PLAN低水平组相较于高水平组均有更长的PFS和OS。治疗前C-PLAN的得分占比在PFS预测模型中最高,治疗后C-PLAN的得分占比在OS预测模型中最高,C-PLAN水平对患者生存结局的预测效能可能更好。结论 C-PLAN指数可以作为晚期NSCLC患者免疫治疗预后的有效预测因子。

       

      Abstract: Objective To evaluate the prognostic significance of C-PLAN index, comprising C-reactive protein (CRP), performance status (PS), lactate dehydrogenase (LDH), albumin (ALB), and derived neutrophil-to-lymphocyte ratio (dNLR), in patients with advanced non-small cell lung cancer (NSCLC) after first-line immunotherapy.Methods A total of 411 patients who were initially diagnosed with advanced NSCLC and received immunotherapy at the Affiliated Hospital of Xuzhou Medical University between January 2019 and January 2024. The patients were randomly divided into a training cohort (n=288) and a validation cohort (n=123) in a 7:3 ratio. The C-PLAN index was calculated within pre-treatment 7 days and at week 6 post-treatment. Progression-free survival (PFS) and overall survival (OS) were recorded during follow-up. Both cohorts were compared for clinical and pathological characteristics, and the association between C-PLAN index and treatment efficacy was analyzed. Kaplan-Meier survival curves were plotted, and the log-rank test was used to assess survival differences. Univariate and multivariate Cox regression analyses were performed on the training cohort to construct prediction models, and receiver operating characteristic (ROC) curves and calibration curves were plotted to evaluate prediction performance.Results In the training cohort, the objective response rate (ORR) and disease control rate (DCR) were 30.6% and 41.0%, respectively; in the validation cohort, ORR and DCR were 34.1% and 44.7%. Both pre-treatment and week 6 post-treatment, both high and low C-PLAN indexes were significantly associated with ORR and DCR (P<0.05), with lower C-PLAN indexes correlating with prolonged PFS and OS. In the prediction models, the pre-treatment C-PLAN index contributed most to PFS prediction, while the post-treatment C-PLAN index was most influential for OS prediction, indicating its potential as a robust prognostic indicator.Conclusions The C-PLAN index can serve as an effective prognostic factor for advanced NSCLC patients undergoing immunotherapy.

       

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