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

作者：Chen W, Liang Y, Hou Q, Cao X, Zhao A, Wu B, Zhou Y, Zhang W, Zhao M, Yao N, Li F, Duan J, Zhang S, Li N, Cao J · 发表于：Frontiers in immunology · 年份：2026 · DOI：10.3389/fimmu.2026.1734341 · 被引用次数：41 · 研究领域：Carcinoma, Non-Small-Cell Lung、Lung Neoplasms、Immunotherapy、Humans、Female、Male、Retrospective Studies、Middle Aged、Lymphocyte Count、Aged、Neoplasm Staging、Risk Assessment

PURPOSE: 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. MATERIALS AND METHODS: 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 < 0.54×109/L. RESULTS: EDRIC inversely correlated with RT-NLC (r = -0.38, P < 0.001). Lower EDRIC was associated with significantly improved median overall survival (OS: 49.7 vs. 38.1 months, P = 0.015), progression-free survival (PFS: 29.7 vs. 17.3 months, P = 0.006), locoregional relapse-free survival (LRFS: 32.4 vs. 19.8 months, P = 0.004), and distant metastasis-free survival (DMFS: 44.8 vs. 24.0 months, P = 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, P = 0.012). High-risk patients demonstrated inferior survival (P < 0.05) but derived significant benefit from consolidation immunotherapy, with improved OS (HR...