Risk stratification model based on estimated dose of radiation to immune cells and radiotherapy-related nadir lymphocyte count for predicting the efficacy of consolidation immunotherapy in stage III non-small cell lung cancer.
This study aimed to evaluate the prognostic value of the estimated dose of radiation to immune cells (EDRIC) and the radiotherapy-related nadir lymphocyte count (RT-NLC), and to establish a risk stratification model for predicting outcomes in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with definitive chemoradiotherapy (CRT) and immunotherapy.
We retrospectively analyzed 136 patients treated between May 2019 and November 2023. EDRIC and RT-NLC were dichotomized at median values. Survival analysis was performed using Kaplan-Meier and Cox regression. High-risk patients were defined as having EDRIC ≥ 6.75 Gy and RT-NLC < 0.54×109/L.
EDRIC inversely correlated with RT-NLC (r = -0.38, P < 0.001). Lower EDRIC was associated with significantly improved median overall survival (OS: 49.7 vs. 38.1 months, P = 0.015), progression-free survival (PFS: 29.7 vs. 17.3 months, P = 0.006), locoregional relapse-free survival (LRFS: 32.4 vs. 19.8 months, P = 0.004), and distant metastasis-free survival (DMFS: 44.8 vs. 24.0 months, P = 0.001). On multivariable analysis, low EDRIC independently predicted improved OS (HR = 0.51), PFS (HR = 0.56), LRFS (HR = 0.53), and DMFS (HR = 0.42). High RT-NLC group was significantly prolonged median DMFS (44.8 vs 26.8 months, P = 0.012). High-risk patients demonstrated inferior survival (P < 0.05) but derived significant benefit from consolidation immunotherapy, with improved OS (HR = 0.37, P = 0.041), PFS (HR = 0.44, P = 0.034), and DMFS (HR = 0.33, P = 0.011).
EDRIC and RT-NLC are significant prognostic biomarkers in unresectable stage III NSCLC. A risk model integrating these parameters effectively identifies high-risk patients who obtain substantial survival benefit, particularly in distant metastasis control, from consolidation immunotherapy, supporting personalized treatment strategies. Prospective validation is warranted.
We retrospectively analyzed 136 patients treated between May 2019 and November 2023. EDRIC and RT-NLC were dichotomized at median values. Survival analysis was performed using Kaplan-Meier and Cox regression. High-risk patients were defined as having EDRIC ≥ 6.75 Gy and RT-NLC < 0.54×109/L.
EDRIC inversely correlated with RT-NLC (r = -0.38, P < 0.001). Lower EDRIC was associated with significantly improved median overall survival (OS: 49.7 vs. 38.1 months, P = 0.015), progression-free survival (PFS: 29.7 vs. 17.3 months, P = 0.006), locoregional relapse-free survival (LRFS: 32.4 vs. 19.8 months, P = 0.004), and distant metastasis-free survival (DMFS: 44.8 vs. 24.0 months, P = 0.001). On multivariable analysis, low EDRIC independently predicted improved OS (HR = 0.51), PFS (HR = 0.56), LRFS (HR = 0.53), and DMFS (HR = 0.42). High RT-NLC group was significantly prolonged median DMFS (44.8 vs 26.8 months, P = 0.012). High-risk patients demonstrated inferior survival (P < 0.05) but derived significant benefit from consolidation immunotherapy, with improved OS (HR = 0.37, P = 0.041), PFS (HR = 0.44, P = 0.034), and DMFS (HR = 0.33, P = 0.011).
EDRIC and RT-NLC are significant prognostic biomarkers in unresectable stage III NSCLC. A risk model integrating these parameters effectively identifies high-risk patients who obtain substantial survival benefit, particularly in distant metastasis control, from consolidation immunotherapy, supporting personalized treatment strategies. Prospective validation is warranted.
Authors
Chen Chen, Liang Liang, Hou Hou, Cao Cao, Zhao Zhao, Wu Wu, Zhou Zhou, Zhang Zhang, Zhao Zhao, Yao Yao, Li Li, Duan Duan, Zhang Zhang, Li Li, Cao Cao
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