| 李妍,彭心怡,孔燕妮,郭勇.免疫检查点抑制剂疗效预测分析及结合中医证型的Nomogram图构建[J].浙江中西医结合杂志,2021,31(8): |
| 免疫检查点抑制剂疗效预测分析及结合中医证型的Nomogram图构建 |
| Prediction of Efficacy of Immune Checkpoint Inhibitors and Nomogram Construction Combined with TCM ZhengLi Yan1, Peng Xin-Yi 2,Kong Yan-Ni2,Guo Yong2 |
| 投稿时间：2021-04-13 修订日期：2021-07-06 |
| DOI： |
| 中文关键词: 免疫检查点抑制剂 中医证候 Nomogram模型 预后分析 |
| 英文关键词:immune checkpoint inhibitors, TCM zheng, Nomogram model prognostic analyses. |
| 基金项目:国家自然科学(No. 81973805)；浙江省中医药科技计划(No. 2015ZA088)；“十三五”浙江省中医药(中西医结合)重点学科建设(2017-XK-A09) |
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| 中文摘要: |
| 目的 评估影响免疫检查点抑制剂疗效的预测因素并构建中医证型参与的疗效预测模型。方法 本研究纳入临床符合入组标准的53例正在行免疫检查点抑制剂治疗的IV期常见恶性实体肿瘤患者，应用SPSS24.0及R统计软件进行数据分析，采用Cox比例风险回归模型分析外周血代谢、免疫相关指标及临床参数对免疫治疗客观缓解时间的贡献度并进行生存预后列线图（Nomogram图）的构建，分析其预测免疫治疗疗效的能力。结果 提取本中心2019.02~2021.02月的53例正在接受免疫检查点抑制剂治疗恶性肿瘤患者临床资料，对14个临床参数进行单因素COX回归分析发现：前白蛋白(p=0.003)与淀粉样蛋白a(p=0.046)与客观缓解时间获益有关；进一步行多因素COX回归分析结果表明，年龄（p<0.01）,T分期（p<0.01），N分期（p<0.01），治疗线数（p<0.01），联合治疗情况（p<0.01），中医证型（p<0.01），不同免疫检查点抑制剂（p<0.01）及瘤种（p<0.01）是患者获得客观缓解时间获益的独立预后影响因素。采用相关因素构建Nomogram图，内部验证结果表明，C指数为C指数为0.7309（95%CI为0.6391~0.8228），表现出良好的预测价值。结论 前白蛋白、淀粉样蛋白a、年龄、治疗线数、联合治疗、瘤种、不同免疫检查点抑制剂、中医证型是影响免疫检查点抑制剂客观缓解时间获益的独立预测指标，结合中医证型及临床参数的Nomogram图模型可能作为免疫检查点抑制剂疗效判断的预测模型。 |
| 英文摘要: |
| Objective To evaluate the predictors of the efficacy of immune checkpoint inhibitors and to establish the efficacy prediction model with TCM Zheng. Methods This research into clinical accords with the standard set of line 53 is immune checkpoint inhibitor treatment of patients with stage IV common malignant solid tumors, application SPSS24.0 and R statistical software for data analysis, by using the Cox proportional hazards regression model analysis of peripheral blood metabolic, immune related indicators and clinical parameters of immunotherapy objective response time and make contribution to the survival of prognostic Nomogram (Nomogram chart) to build, analyze its ability to predict the immune therapy efficacy. Results The clinical data of 53 patients receiving immune-checkpoint inhibitors for malignant tumors from February, 2019.02 to February, 2021.02 in our center were extracted. Univariate Cox regression analysis of 14 clinical parameters showed that prealbumin (P =0.003) and amyloid A (P =0.046) were associated with objective remission time benefit. Multiariable COX regression analysis results showed that the age (p < 0.01), T staging (p < 0.01), and N staging (p < 0.01), number of treatment line (p < 0.01), joint treatment (p < 0.01), different type of syndrome (p < 0.01), immune checkpoint inhibitors (p < 0.01) and tumor (p < 0.01) is to obtain objective response time to benefit patients with independent prognostic factors. Based on relevant factors, the internal verification results of Nomogram plot show that the C index is 0.7309 (95%CI 0.6391~0.8228), showing good predictive value. Conclusion Prealbumin, amyloid protein a, age, treatment lines, combined treatment, tumor types, different immune checkpoint inhibitors, TCM Zheng is the independent predictor of the objective remission time benefit of immune checkpoint inhibitors. Nomogram graph model of TCM Zheng and other clinical parameters may be as an important immune checkpoint inhibitors curative effect judgment prediction model. |
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