| Background: Evidence for the effects of immunotherapy in non-small cell lung cancer(NSCLC)patients with distant organ metastasis is insufficient,and the predictive efficacy of established markers in tissue and blood is elusive.Our study aimed to determine the prognostic factors and develop a survival prognosis model for these patients.Methods: This study accrued 100 advanced NSCLC patients who received single or combination ICIs in Xijing hospital between June 2018 and June 2021 were eligible for retrospective enrollment.All the enrolled patients showed distant organ metastases before receiving immunotherapy.The major clinicopathological parameters were collected and associated survival outcomes were followed up to assess their prognoses.Subsequently,X-tile software and restricted cube histogram were used to determine the optimal truncation values of clinical variables.Univariate and multivariate COX regression analyses were performed to determine the candidate factors in these patients.Overall patient survival in groups of high,intermediate,and low expression was analyzed by Kaplan-Meier survival curve.Furthermore,the nomogram and corresponding web page were developed based on the predictive model.The predictive ability of the model was evaluated by the concordance index(C-index),calibration plot.Results: Multivariate COX proportional hazards analysis indicated that ECOG PS ≥ 2(P< 0.001),BMI > 23.77(P = 0.003),ACCI > 8(P = 0.004),LDH > 222(P = 0.012),and ANC(P = 0.007)correlated significantly with OS.Based on these five predictive factors,a nomogram was constructed with a C-index of 0.81 and a 95%CI of 0.778-0.842.The corresponding dynamic nomograph for APP was constructed using https://lucky-wm-nomogram.shinyapps.io/Dyn Nomapp/.The calibration plot and time-ROC curve indicated a good prediction probability of the mode(1-,2-,and 3-year AUCs were 0.934,0.829,and 0.846).According to the critical point of the model,the patients were divided into the high-(TPS > 258),middle-(204 < TPS ≤ 258),and low-risk groups(TPS ≤ 204).Significant OS differences were observed among the three subgroups(median OS: 4.8 months vs 13.0 months vs 32.9 months).In addition,we analyzed the survival of 5 patients with suspected but distinct from hyper-progressive disease(HPD),which was manifested as new liver metastases despite significant response to immunotherapy in the primary site.Conclusion: Based on common clinical indicators,we developed a feasible and practical model to predict the prognosis of NSCLC patients with distant organ metastasis prior to immunotherapy.Our findings are promising for screening the potential benefits of immunotherapy patients in routine clinical practice until the development of novel biomarkers.In addition,the occurrence of new liver metastases in patients after immunotherapy further indicates that pathology,radiology,and molecular typing evaluation should be carried out throughout the treatment regimen,which is of great significance for the identification and evaluation of similarities and differences with HPD. |
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