Construction of a Prediction Model for Risk of Poor Prognosis in Non-small Cell Lung Cancer Treated with Immunotherapy Based on a Prospective Longitudinal Cohort
ZHU Jie
TAN Yongchuan
MIN Xuli
YAO Ke
Abstract：Objective To construct a prediction model for the risk of poor prognosis in non-small cell lung cancer(NSCLC)patients receiving immunotherapy based on a prospective longitudinal cohort.Methods An analysis was conducted on clinical data of 282 NSCLC patients treated with immune checkpoint inhibitor(ICIs)at Nanchong Mental and Physical Hospital from January 2022 to January 2025.Based on prognosis,patients were divided into a poor prognosis group(119 cases)and a good prognosis group(163 cases).Differences in general data and laboratory indicators before treatment and after 2 treatment cycles—including neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammation index(SII),systemic inflammation response index(SIRI),and T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+)—were compared between the two groups.Cox proportional hazards regression analysis was used to identify influencing factors for poor prognosis in NSCLC patients receiving immunotherapy.A nomogram was constructed to build a prediction model for the risk of poor prognosis.ROC curve analysis and the consistency index(C-index)were used to evaluate the model's discrimination.The Bootstrap method was used for repeated sampling for internal validation to assess the model's calibration.Results The poor prognosis group had a lower proportion of ICI as first-line therapy and lower CD4+/CD8+after 2 treatment cycles,but higher NLR,SII,SIRI,and CD8+after 2 treatment cycles compared to the good prognosis group(P<0.05).Multivariate Cox proportional hazards regression analysis showed that NLR and SII after 2 treatment cycles were independent risk factors for poor prognosis in NSCLC patients receiving immunotherapy,while ICI as first-line therapy and CD4+/CD8+after 2 treatment cycles were independent protective factors(HR=3.928,95%CI:2.198-6.015,P<0.001;HR=1.635,95%CI:1.018-2.427,P=0.012;HR=0.457,95%CI:0.239-0.871,P=0.017;HR=0.905,95%CI:0.851-0.986,P=0.010).ROC curve analysis showed that the AUC of the nomogram prediction model for poor prognosis in NSCLC patients receiving immunotherapy was 0.833(95%CI:0.745-0.920),and the C-index was 0.851(95%CI:0.770-0.931),indicating good model discrimination.Internal validation showed good model calibration.Conclusion The line of ICI therapy and CD4+/CD8+,NLR,and SII after 2 treatment cycles may influence the prognosis of advanced NSCLC patients receiving immunotherapy.The nomogram prediction model constructed from these four factors can assist in predicting the risk of poor prognosis.
Keywords：non-small cell lung cancerimmunotherapyimmune checkpoint inhibitorprognosisprogress-free survivalprediction
Publication Date：2026-01-20
Online Publishing Date：2026-01-24(First online date of this platform, not the publication date of the document)
Pages：7( 129-135 )