Risk stratification model based on estimated dose of radiation to immune cells and radiotherapy-related nadir lymphocyte count for predicting the efficacy of consolidation immunotherapy in stage III non-small cell lung cancer.
本研究旨在评估免疫细胞估计辐射剂量（EDRIC）与放疗相关淋巴细胞最低值（RT-NLC）的预后价值，并建立风险分层模型以预测接受根治性放化疗（CRT）联合免疫治疗不可切除III期非小细胞肺癌（NSCLC）患者的结局。我们回顾性分析了2019年5月至2023年11月期间接受治疗的136例患者。EDRIC和RT-NLC按中位数进行二分类。采用Kaplan-Meier法和Cox回归进行生存分析。高风险患者定义为EDRIC ≥ 6.75 Gy且RT-NLC < 0.54×10⁹/L。EDRIC与RT-NLC呈负相关（r = -0.38，P < 0.001）。较低的EDRIC与显著改善的中位总生存期（OS：49.7 vs. 38.1个月，P = 0.015）、无进展生存期（PFS：29.7 vs. 17.3个月，P = 0.006）、无局部区域复发生存期（LRFS：32.4 vs. 19.8个月，P = 0.004）和无远处转移生存期（DMFS：44.8 vs. 24.0个月，P = 0.001）相关。多因素分析显示，低EDRIC独立预测改善的OS（HR = 0.51）、PFS（HR = 0.56）、LRFS（HR = 0.53）和DMFS（HR = 0.42）。高RT-NLC组的中位DMFS显著延长（44.8 vs. 26.8个月，P = 0.012）。高风险患者生存较差（P < 0.05），但从巩固免疫治疗中获得显著获益，OS（HR = 0.37，P = 0.041）、PFS（HR = 0.44，P = 0.034）和DMFS（HR = 0.33，P = 0.011）均改善。EDRIC和RT-NLC是不可切除III期NSCLC的重要预后生物标志物。整合这些参数的风险模型可有效识别从巩固免疫治疗中获得显著生存获益的高风险患者，尤其在远处转移控制方面，支持个性化治疗策略。尚需前瞻性验证。
This study aimed to evaluate the prognostic value of the estimated dose of radiation to immune cells (EDRIC) and the radiotherapy-related nadir lymphocyte count (RT-NLC), and to establish a risk stratification model for predicting outcomes in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with definitive chemoradiotherapy (CRT) and immunotherapy. We retrospectively analyzed 136 patients treated between May 2019 and November 2023. EDRIC and RT-NLC were dichotomized at median values. Survival analysis was performed using Kaplan-Meier and Cox regression. High-risk patients were defined as having EDRIC ≥ 6.75 Gy and RT-NLC < 0.54×10/L. EDRIC inversely correlated with RT-NLC (r = -0.38, < 0.001). Lower EDRIC was associated with significantly improved median overall survival (OS: 49.7 vs. 38.1 months, = 0.015), progression-free survival (PFS: 29.7 vs. 17.3 months, = 0.006), locoregional relapse-free survival (LRFS: 32.4 vs. 19.8 months, = 0.004), and distant metastasis-free survival (DMFS: 44.8 vs. 24.0 months, = 0.001). On multivariable analysis, low EDRIC independently predicted improved OS (HR = 0.51), PFS (HR = 0.56), LRFS (HR = 0.53), and DMFS (HR = 0.42). High RT-NLC group was significantly prolonged median DMFS (44.8 vs 26.8 months, = 0.012). High-risk patients demonstrated inferior survival ( < 0.05) but derived significant benefit from consolidation immunotherapy, with improved OS (HR = 0.37, = 0.041), PFS (HR = 0.44, = 0.034), and DMFS (HR = 0.33, = 0.011). EDRIC and RT-NLC are significant prognostic biomarkers in unresectable stage III NSCLC. A risk model integrating these parameters effectively identifies high-risk patients who obtain substantial survival benefit, particularly in distant metastasis control, from consolidation immunotherapy, supporting personalized treatment strategies. Prospective validation is warranted.
Wenlu Chen, Yu Liang, Qing Hou, Xin Cao, Anqi Zhao, Baixue Wu, et al. Risk stratification model based on estimated dose of radiation to immune cells and radiotherapy-related nadir lymphocyte count for predicting the efficacy of consolidation immunotherapy in stage III non-small cell lung cancer.. Frontiers in immunology. 2026; doi:10.3389/fimmu.2026.1734341.
Wenlu Chen, Yu Liang, Qing Hou, Xin Cao, Anqi Zhao, Baixue Wu, et al (2026). Risk stratification model based on estimated dose of radiation to immune cells and radiotherapy-related nadir lymphocyte count for predicting the efficacy of consolidation immunotherapy in stage III non-small cell lung cancer.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1734341
Wenlu Chen, Yu Liang, Qing Hou, Xin Cao, Anqi Zhao, Baixue Wu, et al. Risk stratification model based on estimated dose of radiation to immune cells and radiotherapy-related nadir lymphocyte count for predicting the efficacy of consolidation immunotherapy in stage III non-small cell lung cancer.[J]. Frontiers in immunology, 2026 doi:10.3389/fimmu.2026.1734341.
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