Prognostic risk factors and a survival prediction model for immune checkpoint inhibitor related myocarditis in patients with lung cancer: a multicenter study.

IF 3.9 2区 综合性期刊 Q1 MULTIDISCIPLINARY SCIENCES
Xiaoyun Cheng, Lingzhi Long, Yuzhang Li, Xia Gan, Pan Yu, Xiangyu Zhang, Guoliang Jiang, Tingting Yao, Mao Jiang, Wei Xie, Jie Meng
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引用次数: 0

Abstract

Immune checkpoint inhibitor (ICI)-related myocarditis is a rare but fatal immune-related adverse event in lung cancer patients, with limited multivariate prognostic analysis. This study aimed to identify risk factors for severity, major adverse cardiac events (MACE) and survival time, and develop a survival prediction model. Data from 70 lung cancer patients with ICI-related myocarditis (training set) and 40 patients (validation set) were analyzed, with ≥ 1.5 years of follow-up. Cox regression was employed to determine factors associated with survival time, and Logistic regression models identified risk factors for severe myocarditis and MACE. Several factors were independently associated with all-cause death: protective factors included combined radiotherapy (HR 0.12, 95%CI: 0.01-0.98, p = 0.047) and longer ICI treatment duration (≥ 132 days, HR 0.93, 95%CI: 0.91-0.98, p = 0.013); risk factors included low-dose glucocorticoid use in patients with severe myocarditis (HR 3.92, 95%CI: 1.16-13.2, p = 0.028). A nomogram model constructed based on these three variables yielded area under the time-ROC curves of 0.832, 0.835, and 0.924 for 0.5-, 1-, and 1.5-year survival in the training set, and 0.821, 0.806, and 0.789 in the validation set, respectively. It also demonstrated good discriminative ability and clinical utility for predicting survival in lung cancer patients with ICI-related myocarditis, as this study established a validated nomogram model that may aid survival prediction in this population. Additionally, we analyzed the risk factors for severe ICI related myocarditis and 90-day MACE. We found that the use of angiogenesis inhibitors was an independent risk factor for severe myocarditis (OR 18.72, 95% CI: 2.52-428.27, p = 0.02); a history of coronary artery disease (OR 10.54, 95% CI: 1.62-210.10, p = 0.037) was an independent risk factor for 90-day MACE; and left ventricular ejection fraction (OR 0.94, 95% CI: 0.88-0.99, p = 0.026) was an independent protective factor against 90-day MACE.

肺癌患者免疫检查点抑制剂相关心肌炎的预后危险因素和生存预测模型:一项多中心研究
免疫检查点抑制剂(ICI)相关心肌炎是肺癌患者中一种罕见但致命的免疫相关不良事件,其多因素预后分析有限。本研究旨在确定严重程度、主要心脏不良事件(MACE)和生存时间的危险因素,并建立生存预测模型。分析70例肺癌合并ici相关性心肌炎患者(训练集)和40例患者(验证集)的数据,随访≥1.5年。采用Cox回归确定与生存时间相关的因素,Logistic回归模型确定严重心肌炎和MACE的危险因素。多个因素与全因死亡独立相关:保护因素包括联合放疗(HR 0.12, 95%CI: 0.01-0.98, p = 0.047)和较长的ICI治疗时间(≥132天,HR 0.93, 95%CI: 0.91-0.98, p = 0.013);危险因素包括严重心肌炎患者使用低剂量糖皮质激素(HR 3.92, 95%CI: 1.16-13.2, p = 0.028)。基于这三个变量构建的nomogram模型,训练集的0.5年、1年和1.5年生存率的时间- roc曲线下面积分别为0.832、0.835和0.924,验证集的时间- roc曲线下面积分别为0.821、0.806和0.789。该模型在预测肺癌合并ici相关性心肌炎患者的生存方面也显示出良好的判别能力和临床应用价值,因为本研究建立了一个有效的nomogram模型,可以帮助预测该人群的生存。此外,我们分析了严重ICI相关心肌炎和90天MACE的危险因素。我们发现血管生成抑制剂的使用是严重心肌炎的独立危险因素(OR 18.72, 95% CI: 2.52-428.27, p = 0.02);冠状动脉病史(OR 10.54, 95% CI: 1.62-210.10, p = 0.037)是90天MACE的独立危险因素;左室射血分数(OR 0.94, 95% CI: 0.88-0.99, p = 0.026)是预防90天MACE的独立保护因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Scientific Reports
Scientific Reports Natural Science Disciplines-
CiteScore
7.50
自引率
4.30%
发文量
19567
审稿时长
3.9 months
期刊介绍: We publish original research from all areas of the natural sciences, psychology, medicine and engineering. You can learn more about what we publish by browsing our specific scientific subject areas below or explore Scientific Reports by browsing all articles and collections. Scientific Reports has a 2-year impact factor: 4.380 (2021), and is the 6th most-cited journal in the world, with more than 540,000 citations in 2020 (Clarivate Analytics, 2021). •Engineering Engineering covers all aspects of engineering, technology, and applied science. It plays a crucial role in the development of technologies to address some of the world''s biggest challenges, helping to save lives and improve the way we live. •Physical sciences Physical sciences are those academic disciplines that aim to uncover the underlying laws of nature — often written in the language of mathematics. It is a collective term for areas of study including astronomy, chemistry, materials science and physics. •Earth and environmental sciences Earth and environmental sciences cover all aspects of Earth and planetary science and broadly encompass solid Earth processes, surface and atmospheric dynamics, Earth system history, climate and climate change, marine and freshwater systems, and ecology. It also considers the interactions between humans and these systems. •Biological sciences Biological sciences encompass all the divisions of natural sciences examining various aspects of vital processes. The concept includes anatomy, physiology, cell biology, biochemistry and biophysics, and covers all organisms from microorganisms, animals to plants. •Health sciences The health sciences study health, disease and healthcare. This field of study aims to develop knowledge, interventions and technology for use in healthcare to improve the treatment of patients.
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