Background:Epidermal growth factor receptor (EGFR) mutations are presented in approximately 50% of East Asian populations with advanced non-small cell lung cancer (NSCLC). While EGFR-tyrosine kinase inhibitors (TKIs) are the standard treatment, patient outcomes are also influenced by host-related factors. This study aimed to investigate clinical and radiological factors associated with early mortality and develop a prognostic prediction model in advanced EGFR-mutated NSCLC.Methods:A retrospective cohort was conducted in patients with EGFR-mutated NSCLC treated with first line EGFR-TKIs from January 2012 to October 2022 at Chiang Mai University Hospital. Clinical data and radiologic findings at the initiation of treatment were analyzed. A multivariable flexible parametric survival model was used to determine the predictors of death at 18 months. The predicted survival probabilities at 6, 12, and 18 months were estimated, and the model performance was evaluated.Results:Among 189 patients, 84 (44.4%) died within 18 months. Significant predictors of mortality included body mass index <18.5 or ≥23, bone metastasis, neutrophil-to-lymphocyte ratio ≥ 5, albumin-to-globulin ratio < 1, and mean pulmonary artery diameter ≥ 29 mm. The model demonstrated good performance (Harrell’s C-statistic = 0.72; 95% CI: 0.66–0.78). Based on bootstrap internal validation, the optimism-corrected Harrell’s C-statistic was 0.71 (95% CI: 0.71–0.71), derived from an apparent C-statistic of 0.75 (95% CI: 0.74–0.75) and an estimated optimism of 0.04 (95% CI: 0.03–0.04). Estimated 18-month survival ranged from 87.1% in those without risk factors to 2.1% in those with all predictors. A web-based tool was developed for clinical use.Conclusions:The prognostic model developed from fundamental clinical and radiologic parameters demonstrated promising utility in predicting 18-month mortality in patients with advanced EGFR-mutated NSCLC receiving first-line EGFR-TKI therapy.
背景：在东亚晚期非小细胞肺癌（NSCLC）患者中，约50%存在表皮生长因子受体（EGFR）突变。虽然EGFR-酪氨酸激酶抑制剂（TKIs）是标准治疗方案，但患者预后同时受宿主相关因素影响。本研究旨在探讨与早期死亡相关的临床及影像学因素，并构建晚期EGFR突变NSCLC的预后预测模型。 方法：回顾性纳入2012年1月至2022年10月在清迈大学医院接受一线EGFR-TKIs治疗的EGFR突变NSCLC患者队列。分析治疗起始时的临床资料与影像学表现。采用多变量灵活参数生存模型确定18个月内死亡预测因子，估算6、12及18个月的生存概率，并评估模型性能。 结果：在189例患者中，84例（44.4%）于18个月内死亡。显著死亡预测因子包括：体重指数<18.5或≥23、骨转移、中性粒细胞与淋巴细胞比值≥5、白蛋白与球蛋白比值<1、平均肺动脉直径≥29 mm。模型表现出良好性能（Harrell's C统计量=0.72；95% CI：0.66–0.78）。经Bootstrap内部验证，乐观校正后的Harrell's C统计量为0.71（95% CI：0.71–0.71），其源自表观C统计量0.75（95% CI：0.74–0.75）与估计乐观度0.04（95% CI：0.03–0.04）。无风险因素者18个月生存率估计为87.1%，而具备全部预测因素者仅为2.1%。研究同时开发了可供临床应用的网络工具。 结论：基于基础临床与影像学参数构建的预后模型，在预测接受一线EGFR-TKI治疗的晚期EGFR突变NSCLC患者18个月死亡率方面展现出良好的应用潜力。
肿瘤(癌症)患者之家