衰弱对接受EGFR-TKI治疗的老年非小细胞肺癌患者预后的影响及列线图模型构建

doi:10.3969/j.issn.1003-9198.2026.06.007

摘要/Abstract

摘要： 目的探讨老年非小细胞肺癌(NSCLC)患者经表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)治疗前衰弱状态对预后的影响,并基于此构建预后预测模型。方法回顾性分析2020年1月至2023年12月邯郸市中心医院221例接受EGFR-TKI治疗的老年NSCLC患者临床资料。治疗前采用简化5因素修正衰弱指数(mFI-5)评估患者衰弱状态,以总生存期(OS)为随访终点,随访截至2025年8月1日。结果共53例(24.0%)患者治疗前存在衰弱。随访期间22例(10.0%)死亡。多因素logistic回归分析显示,胸膜侵犯、淋巴侵犯、高龄、肿瘤大小、吸烟指数是患者衰弱的独立相关因素(P＜0.05);多因素Cox回归结果显示,淋巴侵犯、鳞状细胞癌、吸烟指数、衰弱状态是患者预后不良的独立危险因素(P＜0.05)。衰弱患者中位生存期为2.71年,显著低于非衰弱患者(中位生存期未达到,Log rank P＜0.001)。基于上述4项预后危险因素构建列线图模型,经Bootstrap法内部验证(重复抽样1000次),模型的一致性指数(C-index)为0.79,ROC曲线分析显示其预测预后不良的AUC为0.81(95%CI:0.69～0.92)。结论基于mFI-5评估的衰弱状态与接受EGFR-TKI治疗的老年NSCLC患者OS降低相关。本研究初步构建的包含衰弱状态、淋巴侵犯、鳞状细胞癌、吸烟指数的列线图模型,展现出一定的预后预测潜力。

关键词: 老年人, 非小细胞肺癌, 表皮生长因子受体酪氨酸激酶抑制剂, 衰弱, 预后

Abstract: Objective To investigate the impact of frailty before treatment on the prognosis of elderly patients with non-small cell lung cancer (NSCLC) receiving epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy, and to construct a prognostic prediction model. Methods A retrospective analysis was performed on clinical data of 221 elderly NSCLC patients treated with EGFR-TKI in Handan Central hospital from January 2020 to December 2023. The simplified 5-factor modified frailty index (mFI-5) was used to assess frailty status before treatment. Overall survival (OS) was set as the follow-up endpoint, with follow-up ending on August 1, 2025. Results Among the patients, 53 cases (24.0%) had frailty before treatment and 22 cases (10.0%) died during follow-up. Logistic regression analysis indicated that pleural invasion, lymphatic invasion, advanced age, tumor size and smoking index were independently associated with frailty (P<0.05). Cox regression analysis revealed that lymphatic invasion, squamous cell carcinoma, smoking index and frailty status were independent risk factors for poor prognosis (P<0.05). The median survival time of frail patients was 2.71 years, which was significantly shorter than that of non-frail patients (Log rank P<0.001). A nomogram model was constructed based on the above four prognostic risk factors. Internal validation via the Bootstrap method (1000 resamplings) showed that the concordance index (C-index) of the model was 0.79. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the model for predicting poor prognosis was 0.81(95%CI: 0.69-0.92). Conclusions Frailty status assessed by mFI-5 is associated with decreased OS in elderly NSCLC patients treated with EGFR-TKI. The nomogram model incorporating frailty status, lymphatic invasion, squamous cell carcinoma and smoking index has high predictive value for poor prognosis in these patients.

Key words: aged, non-small cell lung cancer, epidermal growth factor receptor tyrosine kinase inhibitor, frailty, prognosis

中图分类号:

R 743.3

武苗, 李静, 王小英, 秦梦彬. 衰弱对接受EGFR-TKI治疗的老年非小细胞肺癌患者预后的影响及列线图模型构建[J]. 实用老年医学, 2026, 40(6): 573-578.

WU Miao, LI Jing, WANG Xiaoying, QIN Mengbin. Impact of frailty on prognosis and construction of nomogram model for elderly patients with non-small cell lung cancer treated with EGFR-TKI[J]. Practical Geriatrics, 2026, 40(6): 573-578.

参考文献

[1] BRAY F, LAVERSANNE M, SUNG H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263.
[2] LIU S M, ZHENG M M, PAN Y, et al. Emerging evidence and treatment paradigm of non-small cell lung cancer[J]. J Hematol Oncol, 2023, 16(1): 40.
[3] 宋平安, 陈晓亮, 姚远, 等. 程序性死亡蛋白-1抑制剂单药治疗老年晚期非小细胞肺癌患者的疗效及安全性研究[J]. 中国全科医学, 2023, 26(2): 241-247.
[4] NAVARRETE-REYES A P, MATEOS-SORIA A S, SÁNCHEZ-HERNÁNDEZ J J, et al. Frailty and cancer prognosis[J]. Curr Oncol Rep, 2024, 26(9): 991-1020.
[5] SAPP D G, CORMIER B M, ROCKWOOD K, et al. The frailty index based on laboratory test data as a tool to investigate the impact of frailty on health outcomes: a systematic review and meta-analysis[J]. Age Ageing, 2023, 52(1): afac309.
[6] KOMICI K, BENCIVENGA L, NAVANI N, et al. Frailty in patients with lung cancer: a systematic review and meta-analysis[J]. Chest, 2022, 162(2): 485-497.
[7] TIAN J Y, HAO X Y, CAO F Y, et al. Preoperative frailty assessment predicts postoperative mortality, delirium and pneumonia in elderly lung cancer patients: a retrospective cohort study[J]. Ann Surg Oncol, 2023, 30(12): 7442-7451.
[8] 张从利, 闫妍, 马俊杰, 等. 艾司氯胺酮改善胸腔镜下肺癌根治术老年衰弱患者术后抑郁状态的随机双盲对照试验[J]. 四川大学学报(医学版), 2025, 56(2): 506-513.
[9] BAEK W, PARK S Y, KIM Y. Impact of frailty on the outcomes of patients undergoing degenerative spine surgery: a systematic review and meta-analysis[J]. BMC Geriatr, 2023, 23(1): 771.
[10]MANZETTI M, RUFFILLI A, VIROLI G, et al. Frailty influence on postoperative surgical site infections after surgery for degenerative spine disease and adult spine deformity. Can a frailty index be a valuable summary risk indicator? A systematic review and metanalysis of the current literature[J]. Global Spine J, 2025, 15(2): 1338-1355.
[11]KWEH B T S, LEE H Q, TAN T, et al. Posterior instrumented spinal surgery outcomes in the elderly: a comparison of the 5-item and 11-item modified frailty indices[J]. Global Spine J, 2024, 14(2): 593-602.
[12]SUGIMOTO S, NAGAI S, ITO K, et al. The impact of frailty on surgical outcome of patients with lumbar spinal canal stenosis[J]. Spine Surg Relat Res, 2023, 8(2): 188-194.
[13]OTTAVIANO K E, PALANGE D C, HILL S S, et al. Use of a 5-item modified frailty index for assessing outcomes after hartmann's reversal: an ACS-NSQIP study[J]. Am Surg, 2024, 90(4): 875-881.
[14]CANALES C, MAZOR E, COY H, et al. Preoperative point-of-care ultrasound to identify frailty and predict postoperative outcomes: a diagnostic accuracy study[J]. Anesthesiology, 2022, 136(2): 268-278.
[15]BARBE-RICHAUD J B, FATTORI A, LINDNER V, et al. EGFR-mutant urothelial carcinoma harboring an Ala750_Ile759delinsGlyGly alteration with a primary resistance to polychemotherapy and a sensitivity to osimertinib: a literature review on EGFR alterations and response to EGFR tyrosine kinase inhibitors in cancers[J]. J Clin Med, 2025, 14(9): 3129.
[16]ZHOU H Q, ZHANG Y X, CHEN G, et al. Gefitinib (an EGFR tyrosine kinase inhibitor) plus anlotinib (an multikinase inhibitor) for untreated, EGFR-mutated, advanced non-small cell lung cancer (FL-ALTER): a multicenter phase Ⅲ trial[J]. Signal Transduct Target Ther, 2024, 9(1): 215.
[17]CHEN C L, WANG S T, LIAO W C, et al. A real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage Ⅲ EGFR-mutant adenocarcinoma[J]. BMC Cancer, 2023: 23(1): 847.
[18]ZHANG X, GUO X, GAO Q, et al. Association between cigarette smoking history, metabolic phenotypes, and EGFR mutation status in patients with non-small cell lung cancer[J]. J Thorac Dis, 2023, 15(10): 5689-5699.