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Immune-related cardiotoxicities predict immune checkpoint inhibitors treatment for advanced non-small cell lung cancer: a retrospective multi-center study

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机构: [1]Tongji Univ, Shanghai Peoples Hosp 10, Sch Med, Dept Resp Med, 301 Yanchang Middle Rd, Shanghai 200072, Peoples R China [2]Tongji Univ, Sch Med, Shanghai, Peoples R China [3]Tongji Univ, Shanghai Pulm Hosp, Sch Med, Dept TB, Shanghai, Peoples R China [4]Naval Med Univ, Dept Mil Hlth Stat, Shanghai, Peoples R China [5]Shanghai Jiao Tong Univ, Shanghai Chest Hosp, Sch Med, Dept Resp & Crit Care Med, Shanghai, Peoples R China [6]Shanghai Jiao Tong Univ, Xinhua Hosp, Sch Med, Dept Resp & Crit Care Med, Shanghai, Peoples R China [7]Tongji Univ, Tongji Hosp, Sch Med, Dept Pulm & Crit Care Med, Shanghai, Peoples R China [8]Shanghai Jiao Tong Univ, Shanghai Gen Hosp, Sch Med, Dept Resp & Crit Care Med, Shanghai, Peoples R China [9]Naval Med Univ, Affiliated Hosp 2, Dept Resp & Crit Care Med, Shanghai, Peoples R China [10]Ningbo 2 Hosp, Dept Pulm & Crit Care Med, Ningbo, Peoples R China [11]Shanghai Jiao Tong Univ, Tongren Hosp, Sch Med, Dept Resp & Crit Care Med, Shanghai, Peoples R China [12]Tongji Univ, Shanghai East Hosp, Sch Med, Dept Med Oncol, 150 Jimo Rd, Shanghai 200120, Peoples R China [13]Tongji Univ, Shanghai Peoples Hosp 10, Sch Med, Dept Lab Med, 301 Yanchang Middle Rd, Shanghai 200072, Peoples R China [14]Tongji Univ, Shanghai Peoples Hosp 10, Dept Cardiol, Clin Res Unit,Sch Med, 301 Yanchang Middle Rd, Shanghai 200072, Peoples R China
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关键词: Non-small cell lung cancer (NSCLC) cardiotoxicity immune checkpoint inhibitors (ICIs) immune-related adverse events (irAEs) overall survival (OS)

摘要:
Background: Immune checkpoint inhibitor (ICI) therapy is a cornerstone in the treatment of advanced non-small cell lung cancer (NSCLC), but immune-related cardiotoxicities remain a concern. Whether immune-related cardiotoxicities serve as independent prognostic predictors for NSCLC remains debated. This study aimed to investigate the prognostic value of immune-related cardiotoxicities and develop a predictive model for survival outcomes in NSCLC patients receiving ICI therapy. Methods: This retrospective multi-center study included NSCLC patients from nine centers who received at least one ICI cycle from 2019 to 2024. Demographic and clinical indicators were analyzed for associations with overall survival (OS). A prognostic model based on Cox regression and a nomogram was developed and validated. Results: Of 187 patients, the 1-, 3-, and 5-year survival rates of all participants was 0.903 [95% confidence dinterval (CI) 0.857-0.951], 0.759 (95% CI: 0.666-0.865) and 0.528 (95% CI: 0.361-0.773) respectively and 80 (42.8%) experienced immune-related cardiotoxicities. Kaplan-Meier survival analyses revealed that immune-related cardiotoxicities and immune-related adverse events (irAEs) were not associated with OS (P=0.10; P=0.20). Multivariate Cox regression analyses on OS showed an independent predictive value of platelet-to-lymphocyte ratio (PLR) [hazard ratio (HR) 1.002, 95% CI: 1.000-1.004, P=0.02], carcinoembryonic antigen (CEA) (HR 1.005, 95% CI: 1.002-1.007, P<0.001) and cytokeratin-19 fragment 21-1 (CYFRA21-1) (HR 1.004, 95% CI: 1.001-1.008, P=0.02) for OS in advanced NSCLC patients. A nomogram was constructed and the area under the curve (AUC) was 0.757, 0.741, and 0.815 at 1-, 3-, and 5-year. A prognostic model incorporating PLR, CEA and CYFRA21-1 resulted in an optimal performance to predict the prognosis. Additionally, smoking was associated with the occurrence of immune-related cardiotoxicities. Conclusions: Mild irAEs or immune-related cardiotoxicities (grade 1-2) did not extend median OS in NSCLC patients. The prognostic model incorporating PLR, CEA, and CYFRA21-1 could contribute to predicting the treatment efficacy and prognosis of ICI treatment.

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大类 | 4 区 医学
小类 | 4 区 呼吸系统
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大类 | 4 区 医学
小类 | 4 区 呼吸系统
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第一作者机构: [1]Tongji Univ, Shanghai Peoples Hosp 10, Sch Med, Dept Resp Med, 301 Yanchang Middle Rd, Shanghai 200072, Peoples R China [2]Tongji Univ, Sch Med, Shanghai, Peoples R China
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通讯机构: [1]Tongji Univ, Shanghai Peoples Hosp 10, Sch Med, Dept Resp Med, 301 Yanchang Middle Rd, Shanghai 200072, Peoples R China [2]Tongji Univ, Sch Med, Shanghai, Peoples R China [3]Tongji Univ, Shanghai Pulm Hosp, Sch Med, Dept TB, Shanghai, Peoples R China [4]Naval Med Univ, Dept Mil Hlth Stat, Shanghai, Peoples R China [12]Tongji Univ, Shanghai East Hosp, Sch Med, Dept Med Oncol, 150 Jimo Rd, Shanghai 200120, Peoples R China [13]Tongji Univ, Shanghai Peoples Hosp 10, Sch Med, Dept Lab Med, 301 Yanchang Middle Rd, Shanghai 200072, Peoples R China [14]Tongji Univ, Shanghai Peoples Hosp 10, Dept Cardiol, Clin Res Unit,Sch Med, 301 Yanchang Middle Rd, Shanghai 200072, Peoples R China
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