Dataset Information

A clinical variable-based nomogram could predict the survival for advanced NSCLC patients receiving second-line atezolizumab.

ABSTRACT:

Objective

A nomogram model based on clinical variables was conducted to predict the survival in patients with non-small cell lung cancer (NSCLC) receiving second-line atezolizumab.

Methods

Four hundred and twenty-four patients with NSCLC receiving atezolizumab from OAK study were regarded as the training cohort. Next, a nomogram model based on clinical variables in the training cohort was established to predict the survival of patients receiving atezolizumab. The concordance index, area under curve (AUC), and calibration plots were used to assess the performance of the nomogram model. In addition, 144 patients with NSCLC receiving atezolizumab from POPLAR study were regarded as the test cohort to validate the nomogram model. Using Kaplan-Meier and log-rank test, we compared the survival difference between the high- and low-risk groups, atezolizumab and docetaxel treatment groups, respectively.

Results

We successfully constructed a nomogram model based on different variable scores for predicting the survival in NSCLC patients receiving atezolizumab using the training cohort. According to risk score, patients receiving atezolizumab were divided into the high- and low-risk groups. Importantly, in the training cohort, patients had worse overall survival (OS) in high-risk group compared with the low-risk group (median survival: 252.3 vs. 556.9 days; p < 0.0001). As expected, in the test cohort, the high-risk patients also showed a worse OS (median survival: 288.8 vs. 529.3 days, p = 0.0003). In addition, all the patients from the training and test cohorts could be found the OS benefit from atezolizumab compared with docetaxel (all, p < 0.05).

Conclusions

The clinical variable-based nomogram model could predict the survival benefit for NSCLC patients receiving second-line atezolizumab.

SUBMITTER: Shang X

PROVIDER: S-EPMC8446569 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAt present, there is a lack of studies focusing on the survival prediction of patients with non-small cell lung cancer (NSCLC) receiving atezolizumab in light of gene mutation characteristic.MethodsPatients with NSCLC receiving atezolizumab from the OAK study were defined as the training group. LASSO Cox regressions were applied to establish the gene mutation signature model to predict the overall survival (OS) rate of the training group. NSCLC patients receiving atezolizumab from the POPLAR study were defined as the testing group to validate the gene mutation signature model. In addition, we compared the OS rate between patients receiving atezolizumab and docetaxel classified according to their risk score based on our gene mutation signature model.ResultsWe successfully established a 5-genomic mutation signature that included CREBBP, KEAP1, RAF1, STK11 and TP53 mutations. We found it was superior to the blood tumor mutation burden (bTMB) score and programmed death ligand 1 (PDL1) expression in the prediction of the OS rate for patients receiving atezolizumab. High-risk patients receiving atezolizumab had a worse OS rate compared with low-risk patients in the training (P = 0.0004) and testing (P = 0.0001) groups. In addition, low-risk patients using atezolizumab had a better OS rate compared with those in use of docetaxel for the training (P <0.0001) and testing groups (P = 0.0095). High-risk patients of the training group (P = 0.0265) using atezolizumab had a better OS rate compared with those using docetaxel. However, the OS difference between atezolizumab and docetaxel was not found in high-risk patients from the testing group (P = 0.6403). Multivariate Cox regression analysis showed that the risk model in light of 5-genomic mutation signature was an independent prognostic factor on OS for patients receiving atezolizumab (P <0.0001). In addition, significant OS benefit could only be found in low-risk patients receiving atezolizumab compared with docetaxel (P <0.0001).ConclusionsThe 5-genomic mutation signature could predict OS benefit for patients with NSCLC receiving atezolizumab. Therefore, the establishment of the 5-genomic mutation panel will guide clinicians to identify optimal patients who could benefit from atezolizumab treatment.