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PD-1抑制剂用于晚期食管鳞状细胞癌的疗效预测模型构建
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| 篇名： | PD-1抑制剂用于晚期食管鳞状细胞癌的疗效预测模型构建 |
| TITLE： | Construction of a prediction efficacy model for PD-1 inhibitor in advanced esophageal squamous cell carcinoma |
| 摘要： | 目的 构建晚期食管鳞状细胞癌（ESCC）患者接受程序性死亡受体1（PD-1）抑制剂治疗获得持久临床获益（DCB）的预测模型。方法回顾性收集2020年1月至2023年12月在揭阳市人民医院接受PD-1抑制剂治疗的晚期ESCC患者的临床资料，通过最小绝对收缩和选择算子（Lasso）回归模型筛选预测变量，建立多因素Logistic回归模型预测患者DCB，并基于该模型绘制列线图。通过Bootstrap法对预测模型进行内部验证，采用受试者操作特征曲线、校准曲线、决策曲线分析对预测模型进行评价。结果共纳入91例晚期ESCC患者。Lasso回归与Logistic回归联合分析的结果表明，基线淋巴细胞/单核细胞比值（LMR）[比值比（OR）为1.97，95%置信区间（CI）为1.15～3.36，P＝0.013]、白蛋白（ALB）含量（OR＝1.35，95%CI为1.13～1.60，P＜0.001）、体重指数（BMI）1（正常vs.低：OR＝0.28，95%CI为0.09～0.96，P＝0.042）、BMI2（超重～肥胖vs.低：OR＝0.08，95%CI为0.01～0.59，P＝0.013）及治疗方案（免疫单药vs.免疫联合其他：OR＝0.07，95%CI为0.01～0.50，P＝0.008）是晚期ESCC患者接受PD-1抑制剂获得DCB的预测因素。基于上述指标构建预测模型，经Bootstrap法内部验证，其曲线下面积为0.831（95%CI为0.746～0.904），特异度为74.4%，灵敏度为75.0%。Hosmer-Lemeshow拟合优度检验的χ2＝9.930，P＝0.270，校准曲线的斜率接近1。决策曲线分析结果显示该模型的风险阈值范围在0.1～1.0时具有良好的临床应用价值。结论通过基线LMR、ALB含量、BMI和治疗方案成功构建了预测模型，其在评估晚期ESCC患者接受PD-1抑制剂治疗效果上具有良好的预测能力和临床实用性。 |
| ABSTRACT： | OBJECTIVE To develop a prediction model for durable clinical benefit （DCB） in patients with advanced esophageal squamous cell carcinoma （ESCC） receiving programmed death-1 （PD-1） inhibitor. METHODS The clinical data of patients with advanced ESCC who received PD-1 inhibitor in Jieyang People’s Hospital were retrospectively collected between January 2020 to December 2023. Predictors were screened by least absolute shrinkage and selection operator （Lasso） regression， and a multivariable Logistic regression model was developed to predict DCB. A nomogram was constructed based on the model. Internal validation of the prediction model was performed by using the Bootstrap method， and the model was evaluated by the receiver operating characteristic （ROC） curve， calibration curve， and decision curve analysis. RESULTS A total of 91 patients with advanced ESCC were included. The results of Lasso regression combined with Logistic regression analysis indicated that the baseline lymphocyte monocyte ratio （LMR） [odds ratio （OR）＝1.97， 95% confidence interval （CI）： 1.15-3.36， P＝0.013]， albumin （ALB） content （OR＝1.35， 95%CI： 1.13-1.60， P＜0.001）， body mass index （BMI） category 1 [normal vs. low： OR＝ 0.28， 95%CI （0.09-0.96）， P＝0.042]， BMI category 2 [overweight-obesity vs. low： OR＝0.08， 95%CI （0.01-0.59）， P＝0.013]， and treatment regimen [monotherapy vs. monotherapy combination therapy： OR＝0.07， 95%CI （0.01-0.50）， P＝0.008] were predictive factors for patients with advanced ESCC to achieve DCB when treated with PD-1 inhibitor. A prediction model was constructed based on the above indicators. Internal validation of the model using the Bootstrap method showed an area under the curve of 0.831 （95%CI： 0.746-0.904）， with specificity of 74.4% and sensitivity of 75.0%. The Hosmer-Lemeshow test yielded χ2＝ 9.930， P＝0.270， and the calibration curve slope was close to 1. The decision curve analysis demonstrated that the model exhibited good clinical utility within a threshold range of 0.1 to 1.0. CONCLUSIONS The prediction model based on baseline LMR， ALB content， BMI， and treatment regimen demonstrates robust predictive performance and clinical utility for assessing therapeutic efficacy of PD-1 inhibitor in the treatment of advanced ESCC. |
| 期刊： | 2025年第36卷第17期 |
| 作者： | 吴珊珊；黄晓杰；谢晓纯；黄少楷；黄丽娜；王晓芬 |
| AUTHORS： | WU Shanshan，HUANG Xiaojie，XIE Xiaochun，HUANG Shaokai，HUANG Lina，WANG Xiaofen |
| 关键字： | 食管鳞状细胞癌；PD-1抑制剂；持久临床获益；疗效；预测模型；Lasso回归；多因素Logistic回归；列线图 |
| KEYWORDS： | esophageal squamous cell carcinoma； PD-1 |
| 阅读数： | 3 次 |
| 本月下载数： | 0 次 |
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