老年食管癌免疫治疗预后的预测模型构建

doi:10.3969/j.issn.1003-9198.2025.12.009

摘要/Abstract

摘要： 目的构建并验证老年食管癌病人免疫治疗总生存时间(OS)的列线图预测模型。方法回顾性分析2019年12月至2024年6月在南京医科大学第一附属医院肿瘤内科接受免疫检查点抑制剂治疗的食管鳞癌病人。基于首次免疫治疗前2周的实验室数据,通过Cox回归分析结合逐步回归方法筛选出OS的独立影响因素,建立预测模型并进行内部验证。结果 Cox回归分析结果显示,营养风险评分(geriatric nutritional risk index,GNRI)、中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、M分期、手术及癌胚抗原(CEA)是老年食管癌病人免疫治疗的独立危险因素(P<0.05)。所构建的列线图模型验证显示,一致性指数(c-index)为0.806,经过1000次Bootstrap重复抽样验证,校正后c-index为0.815,校正曲线接近理想。时间依赖性ROC分析表明,该模型在1年和2年的预测效能优异,AUC分别为0.81(95%CI:0.72～0.90)和0.88(95%CI:0.82～0.95)。决策曲线分析(DCA)进一步验证了该列线图模型在临床中具有良好的净获益。结论 GNRI、NLR、M分期、手术和CEA是老年食管癌病人免疫治疗OS的独立预测因子,能够有效评估病人的预后。

关键词: 食管癌, 免疫治疗, 列线图, 影响因素, 老年人

Abstract: Objective To establish and validate a nomogram model for predicting overall survival (OS) in the elderly patients with esophageal cancer treated with immune checkpoint inhibitors (ICIs). Methods The clinical data of the elderly patients with esophageal cancer treated with ICIs at the First Affiliated Hospital with Nanjing Medical University from December 2019 to June 2024 were retrospectively analyzed. The independent prognostic factors were identified using Cox regression combined with stepwise regression based on laboratory data within two weeks before the first immunotherapy session. A predictive nomogram model was constructed and internally validated. Results Geriatric nutritional risk index (GNRI), neutrophil-to-lymphocyte ratio (NLR), M-stage, surgery, and carcinoembryonic antigen (CEA) were independent predictors of OS in elderly patients with esophageal cancer treated with ICIs (P<0.05). The consistency index (c-index) was 0.806 of the predictive model. After 1000 times of Bootstrap resampling validations, the corrected c-index was 0.815.Calibration curves closely matched the ideal line. The area under the curve (AUC) for 1-year and 2-year survival was 0.81 (95%CI: 0.72－0.90) and 0.88 (95%CI: 0.82－0.95) respectively. Decision curve analysis (DCA) confirmed the clinical utility of the model. Conclusions GNRI, NLR, M-stage, surgery, and CEA are valuable prognostic markers for elderly esophageal cancer patients treated with ICIs. The developed nomogram provides an effective tool for individualized survival prediction.

Key words: esophageal cancer, immunotherapy, nomogram, influencing factors, aged

中图分类号:

R 735.1

吕佳佳, 高一腾, 钟孝友, 王琳, 孟丽娟, 樊卫飞. 老年食管癌免疫治疗预后的预测模型构建[J]. 实用老年医学, 2025, 39(12): 1233-1237.

LYU Jiajia, GAO Yiteng, ZHONG Xiaoyou, WANG Lin, MENG Lijuan, FAN Weifei. Establishment of a prediction model for overall survival of immunotherapy in elderly patients with esophageal cancer[J]. Practical Geriatrics, 2025, 39(12): 1233-1237.

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