Comparison of the effectiveness of chemotherapy combined with immunotherapy and chemotherapy alone in advanced biliary tract cancer and construction of the nomogram for survival prediction based on the inflammatory index and controlling nutritional status score
Objective To analyze the effectiveness of combining immune checkpoint inhibitors (ICIs) with first-line therapy in patients with advanced biliary tract cancer (BTC) and explore the biomarkers affecting the prognosis of immunotherapy, to construct a nomogram for the prediction of survival. Methods A...
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| creator | Zhang, Zhengfeng Wang, Dazhen Zhang, Jianji Ruan, Yuli Zhao, Lu Yang, Liu Liu, Ze Yang, Lei Lou, Changjie |
| description | Objective
To analyze the effectiveness of combining immune checkpoint inhibitors (ICIs) with first-line therapy in patients with advanced biliary tract cancer (BTC) and explore the biomarkers affecting the prognosis of immunotherapy, to construct a nomogram for the prediction of survival.
Methods
A retrospective study was conducted to include a total of 209 patients with advanced BTC treated in the first line from 2018 to 2022, divided into a combination therapy group (
n
= 129) and a chemotherapy-only group (
n
= 80) according to whether ICIs were applied in combination. Univariate and multifactorial COX regression analyses were performed on variables that may affect prognosis to identify independent influences on patient prognosis, and this was used to create nomograms, which were then prospectively validated and calibrated.
Results
The median progression-free survival (mPFS) and median overall survival (mOS) of patients in the combination therapy group were higher than those in the chemotherapy alone group [hazard ratio (HR) = 1.152, 95% confidence interval (CI): 0.7848–1.692,
p
= 0.0004, and HR = 1.067, 95% CI: 0.7474–1.524,
p
= 0.0016]. The objective response rate (ORR) of patients in the combination therapy and chemotherapy alone groups was 39.5% (51/129) vs. 27.5% (22/80), and the disease control rate (DCR) between the two groups was 89.9% (116/129) vs. 83.8% (67/80). Univariate analysis revealed the gender, presence of long-term tobacco and alcohol, degree of histological differentiation, serum albumin level, presence of liver metastases, presence of multi-visceral metastases, response, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), glycoprotein antigen 19-9 (CA19-9), systemic inflammatory index (SII), and controlling nutritional status (CONUT) scores were statistically significant with patient prognosis (all
P
values |
| doi_str_mv | 10.1007/s00262-023-03513-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10576733</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2877034753</sourcerecordid><originalsourceid>FETCH-LOGICAL-c452t-6eda4684db6f7b074c12fc9fe44b489a33cae890b5e38a219979ddb1fb9ec6583</originalsourceid><addsrcrecordid>eNp9kk9v1DAQxQOioqXwBThZ4sIlYMdOnJwQWvFPqsQFztbEGe-6iu3Fdhb67XFIaVUOnDyaee_nsfWq6iWjbxil8m2itOmamja8prxlvBaPqwsmeGn1LXtSXVAuaC0pFefVs5SuS9HQYXhanXPZdb1k7OLR2S64I0SbgifBkHxAgsagzvaEHlNam_qALpRJhOMN0cGN1uNEftp8INa5xd_NwE8PxTAHj8R6AtMJvC6u0c4W4g3JEXQmem3GzRd8ynEpF99v4oML-wiOmBBJWuLJnmAmx4iT3XQjpMIsxaq23szgHORQ-NZP-OsvOMcwz9bviV9ytKuzYFKGvCSSdIj4vDozMCd8cXteVt8_fvi2-1xfff30Zff-qtaibXLd4QSi68U0dkaOVArNGqMHg0KMoh-Acw3YD3RskffQsGGQwzSNzIwD6q7t-WX1buMel9HhpLGsBrM6RuvKp6gAVj2ceHtQ-3BSjLayk5wXwutbQgw_FkxZOZs0zjN4DEtSTd8xTksYaJG--kd6HZZYnr6qpCzhkO0KbDaVjiGliOZuG0bVGjO1xUyVmKk_MVOimPhmSkXs9xjv0f9x_QZwNN1_</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2877034753</pqid></control><display><type>article</type><title>Comparison of the effectiveness of chemotherapy combined with immunotherapy and chemotherapy alone in advanced biliary tract cancer and construction of the nomogram for survival prediction based on the inflammatory index and controlling nutritional status score</title><source>SpringerNature Journals</source><source>PubMed Central</source><creator>Zhang, Zhengfeng ; Wang, Dazhen ; Zhang, Jianji ; Ruan, Yuli ; Zhao, Lu ; Yang, Liu ; Liu, Ze ; Yang, Lei ; Lou, Changjie</creator><creatorcontrib>Zhang, Zhengfeng ; Wang, Dazhen ; Zhang, Jianji ; Ruan, Yuli ; Zhao, Lu ; Yang, Liu ; Liu, Ze ; Yang, Lei ; Lou, Changjie</creatorcontrib><description>Objective
To analyze the effectiveness of combining immune checkpoint inhibitors (ICIs) with first-line therapy in patients with advanced biliary tract cancer (BTC) and explore the biomarkers affecting the prognosis of immunotherapy, to construct a nomogram for the prediction of survival.
Methods
A retrospective study was conducted to include a total of 209 patients with advanced BTC treated in the first line from 2018 to 2022, divided into a combination therapy group (
n
= 129) and a chemotherapy-only group (
n
= 80) according to whether ICIs were applied in combination. Univariate and multifactorial COX regression analyses were performed on variables that may affect prognosis to identify independent influences on patient prognosis, and this was used to create nomograms, which were then prospectively validated and calibrated.
Results
The median progression-free survival (mPFS) and median overall survival (mOS) of patients in the combination therapy group were higher than those in the chemotherapy alone group [hazard ratio (HR) = 1.152, 95% confidence interval (CI): 0.7848–1.692,
p
= 0.0004, and HR = 1.067, 95% CI: 0.7474–1.524,
p
= 0.0016]. The objective response rate (ORR) of patients in the combination therapy and chemotherapy alone groups was 39.5% (51/129) vs. 27.5% (22/80), and the disease control rate (DCR) between the two groups was 89.9% (116/129) vs. 83.8% (67/80). Univariate analysis revealed the gender, presence of long-term tobacco and alcohol, degree of histological differentiation, serum albumin level, presence of liver metastases, presence of multi-visceral metastases, response, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), glycoprotein antigen 19-9 (CA19-9), systemic inflammatory index (SII), and controlling nutritional status (CONUT) scores were statistically significant with patient prognosis (all
P
values < 0.05). Multi-factor COX regression analysis was continued for the above variables, and the results showed that NLR, MLR, PLR, SII, and CONUT scores were independent influences on patients’ OS (all
p
values < 0.05). A nomogram (C-index 0.77, 95% CI: 0.71–0.84) was created based on these independent influences and later validated using a validation cohort (C-index 0.75, 95% CI: 0.68–0.81). The time-dependent receiver operator characteristic curve (ROC) showed that the area under curve (AUC) of the training cohort patients at 12, 18, and 24 months was 0.72 (95% CI: 0.63–0.81), 0.75 (95% CI: 0.67–0.85), and 0.77 (95% CI: 0.66–0.87) and the AUC of the validation cohort was 0.69 (95% CI: 0.58–0.79), 0.74 (95% CI: 0.65–0.87), and 0.71 (95% CI: 0.64–0.89), respectively. Finally, calibration was performed using calibration curves, and the results showed that nomograms based on inflammatory metrics and CONUT scores could be used to assess survival (12, 18, and 24 months) in patients with advanced BTC treated with ICIs in the first line.
Conclusion
Patients with advanced BTC benefit more from first-line treatment with standard chemotherapy in combination with ICIs than with chemotherapy alone. In addition, nomograms based on inflammatory metrics and CONUT scores can be used to predict survival at 12, 18, and 24 months in patients with advanced BTC treated with ICIs.</description><identifier>ISSN: 0340-7004</identifier><identifier>EISSN: 1432-0851</identifier><identifier>DOI: 10.1007/s00262-023-03513-4</identifier><identifier>PMID: 37668711</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Biliary tract ; Biliary tract diseases ; Cancer Research ; Chemotherapy ; Cholangiocarcinoma ; Disease control ; Immune checkpoint inhibitors ; Immunology ; Immunotherapy ; Inflammation ; Leukocytes (neutrophilic) ; Lymphocytes ; Medical prognosis ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Monocytes ; Nomograms ; Nutritional status ; Oncology ; Patients ; Prognosis ; Sialyl Lewis a antigen ; Statistical analysis</subject><ispartof>Cancer Immunology, Immunotherapy, 2023-11, Vol.72 (11), p.3635-3649</ispartof><rights>The Author(s) 2023</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c452t-6eda4684db6f7b074c12fc9fe44b489a33cae890b5e38a219979ddb1fb9ec6583</citedby><cites>FETCH-LOGICAL-c452t-6eda4684db6f7b074c12fc9fe44b489a33cae890b5e38a219979ddb1fb9ec6583</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576733/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576733/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,886,27929,27930,41493,42562,51324,53796,53798</link.rule.ids></links><search><creatorcontrib>Zhang, Zhengfeng</creatorcontrib><creatorcontrib>Wang, Dazhen</creatorcontrib><creatorcontrib>Zhang, Jianji</creatorcontrib><creatorcontrib>Ruan, Yuli</creatorcontrib><creatorcontrib>Zhao, Lu</creatorcontrib><creatorcontrib>Yang, Liu</creatorcontrib><creatorcontrib>Liu, Ze</creatorcontrib><creatorcontrib>Yang, Lei</creatorcontrib><creatorcontrib>Lou, Changjie</creatorcontrib><title>Comparison of the effectiveness of chemotherapy combined with immunotherapy and chemotherapy alone in advanced biliary tract cancer and construction of the nomogram for survival prediction based on the inflammatory index and controlling nutritional status score</title><title>Cancer Immunology, Immunotherapy</title><addtitle>Cancer Immunol Immunother</addtitle><description>Objective
To analyze the effectiveness of combining immune checkpoint inhibitors (ICIs) with first-line therapy in patients with advanced biliary tract cancer (BTC) and explore the biomarkers affecting the prognosis of immunotherapy, to construct a nomogram for the prediction of survival.
Methods
A retrospective study was conducted to include a total of 209 patients with advanced BTC treated in the first line from 2018 to 2022, divided into a combination therapy group (
n
= 129) and a chemotherapy-only group (
n
= 80) according to whether ICIs were applied in combination. Univariate and multifactorial COX regression analyses were performed on variables that may affect prognosis to identify independent influences on patient prognosis, and this was used to create nomograms, which were then prospectively validated and calibrated.
Results
The median progression-free survival (mPFS) and median overall survival (mOS) of patients in the combination therapy group were higher than those in the chemotherapy alone group [hazard ratio (HR) = 1.152, 95% confidence interval (CI): 0.7848–1.692,
p
= 0.0004, and HR = 1.067, 95% CI: 0.7474–1.524,
p
= 0.0016]. The objective response rate (ORR) of patients in the combination therapy and chemotherapy alone groups was 39.5% (51/129) vs. 27.5% (22/80), and the disease control rate (DCR) between the two groups was 89.9% (116/129) vs. 83.8% (67/80). Univariate analysis revealed the gender, presence of long-term tobacco and alcohol, degree of histological differentiation, serum albumin level, presence of liver metastases, presence of multi-visceral metastases, response, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), glycoprotein antigen 19-9 (CA19-9), systemic inflammatory index (SII), and controlling nutritional status (CONUT) scores were statistically significant with patient prognosis (all
P
values < 0.05). Multi-factor COX regression analysis was continued for the above variables, and the results showed that NLR, MLR, PLR, SII, and CONUT scores were independent influences on patients’ OS (all
p
values < 0.05). A nomogram (C-index 0.77, 95% CI: 0.71–0.84) was created based on these independent influences and later validated using a validation cohort (C-index 0.75, 95% CI: 0.68–0.81). The time-dependent receiver operator characteristic curve (ROC) showed that the area under curve (AUC) of the training cohort patients at 12, 18, and 24 months was 0.72 (95% CI: 0.63–0.81), 0.75 (95% CI: 0.67–0.85), and 0.77 (95% CI: 0.66–0.87) and the AUC of the validation cohort was 0.69 (95% CI: 0.58–0.79), 0.74 (95% CI: 0.65–0.87), and 0.71 (95% CI: 0.64–0.89), respectively. Finally, calibration was performed using calibration curves, and the results showed that nomograms based on inflammatory metrics and CONUT scores could be used to assess survival (12, 18, and 24 months) in patients with advanced BTC treated with ICIs in the first line.
Conclusion
Patients with advanced BTC benefit more from first-line treatment with standard chemotherapy in combination with ICIs than with chemotherapy alone. In addition, nomograms based on inflammatory metrics and CONUT scores can be used to predict survival at 12, 18, and 24 months in patients with advanced BTC treated with ICIs.</description><subject>Biliary tract</subject><subject>Biliary tract diseases</subject><subject>Cancer Research</subject><subject>Chemotherapy</subject><subject>Cholangiocarcinoma</subject><subject>Disease control</subject><subject>Immune checkpoint inhibitors</subject><subject>Immunology</subject><subject>Immunotherapy</subject><subject>Inflammation</subject><subject>Leukocytes (neutrophilic)</subject><subject>Lymphocytes</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Monocytes</subject><subject>Nomograms</subject><subject>Nutritional status</subject><subject>Oncology</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Sialyl Lewis a antigen</subject><subject>Statistical analysis</subject><issn>0340-7004</issn><issn>1432-0851</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kk9v1DAQxQOioqXwBThZ4sIlYMdOnJwQWvFPqsQFztbEGe-6iu3Fdhb67XFIaVUOnDyaee_nsfWq6iWjbxil8m2itOmamja8prxlvBaPqwsmeGn1LXtSXVAuaC0pFefVs5SuS9HQYXhanXPZdb1k7OLR2S64I0SbgifBkHxAgsagzvaEHlNam_qALpRJhOMN0cGN1uNEftp8INa5xd_NwE8PxTAHj8R6AtMJvC6u0c4W4g3JEXQmem3GzRd8ynEpF99v4oML-wiOmBBJWuLJnmAmx4iT3XQjpMIsxaq23szgHORQ-NZP-OsvOMcwz9bviV9ytKuzYFKGvCSSdIj4vDozMCd8cXteVt8_fvi2-1xfff30Zff-qtaibXLd4QSi68U0dkaOVArNGqMHg0KMoh-Acw3YD3RskffQsGGQwzSNzIwD6q7t-WX1buMel9HhpLGsBrM6RuvKp6gAVj2ceHtQ-3BSjLayk5wXwutbQgw_FkxZOZs0zjN4DEtSTd8xTksYaJG--kd6HZZYnr6qpCzhkO0KbDaVjiGliOZuG0bVGjO1xUyVmKk_MVOimPhmSkXs9xjv0f9x_QZwNN1_</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Zhang, Zhengfeng</creator><creator>Wang, Dazhen</creator><creator>Zhang, Jianji</creator><creator>Ruan, Yuli</creator><creator>Zhao, Lu</creator><creator>Yang, Liu</creator><creator>Liu, Ze</creator><creator>Yang, Lei</creator><creator>Lou, Changjie</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20231101</creationdate><title>Comparison of the effectiveness of chemotherapy combined with immunotherapy and chemotherapy alone in advanced biliary tract cancer and construction of the nomogram for survival prediction based on the inflammatory index and controlling nutritional status score</title><author>Zhang, Zhengfeng ; Wang, Dazhen ; Zhang, Jianji ; Ruan, Yuli ; Zhao, Lu ; Yang, Liu ; Liu, Ze ; Yang, Lei ; Lou, Changjie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c452t-6eda4684db6f7b074c12fc9fe44b489a33cae890b5e38a219979ddb1fb9ec6583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Biliary tract</topic><topic>Biliary tract diseases</topic><topic>Cancer Research</topic><topic>Chemotherapy</topic><topic>Cholangiocarcinoma</topic><topic>Disease control</topic><topic>Immune checkpoint inhibitors</topic><topic>Immunology</topic><topic>Immunotherapy</topic><topic>Inflammation</topic><topic>Leukocytes (neutrophilic)</topic><topic>Lymphocytes</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Monocytes</topic><topic>Nomograms</topic><topic>Nutritional status</topic><topic>Oncology</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Sialyl Lewis a antigen</topic><topic>Statistical analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Zhengfeng</creatorcontrib><creatorcontrib>Wang, Dazhen</creatorcontrib><creatorcontrib>Zhang, Jianji</creatorcontrib><creatorcontrib>Ruan, Yuli</creatorcontrib><creatorcontrib>Zhao, Lu</creatorcontrib><creatorcontrib>Yang, Liu</creatorcontrib><creatorcontrib>Liu, Ze</creatorcontrib><creatorcontrib>Yang, Lei</creatorcontrib><creatorcontrib>Lou, Changjie</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cancer Immunology, Immunotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Zhengfeng</au><au>Wang, Dazhen</au><au>Zhang, Jianji</au><au>Ruan, Yuli</au><au>Zhao, Lu</au><au>Yang, Liu</au><au>Liu, Ze</au><au>Yang, Lei</au><au>Lou, Changjie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of the effectiveness of chemotherapy combined with immunotherapy and chemotherapy alone in advanced biliary tract cancer and construction of the nomogram for survival prediction based on the inflammatory index and controlling nutritional status score</atitle><jtitle>Cancer Immunology, Immunotherapy</jtitle><stitle>Cancer Immunol Immunother</stitle><date>2023-11-01</date><risdate>2023</risdate><volume>72</volume><issue>11</issue><spage>3635</spage><epage>3649</epage><pages>3635-3649</pages><issn>0340-7004</issn><eissn>1432-0851</eissn><abstract>Objective
To analyze the effectiveness of combining immune checkpoint inhibitors (ICIs) with first-line therapy in patients with advanced biliary tract cancer (BTC) and explore the biomarkers affecting the prognosis of immunotherapy, to construct a nomogram for the prediction of survival.
Methods
A retrospective study was conducted to include a total of 209 patients with advanced BTC treated in the first line from 2018 to 2022, divided into a combination therapy group (
n
= 129) and a chemotherapy-only group (
n
= 80) according to whether ICIs were applied in combination. Univariate and multifactorial COX regression analyses were performed on variables that may affect prognosis to identify independent influences on patient prognosis, and this was used to create nomograms, which were then prospectively validated and calibrated.
Results
The median progression-free survival (mPFS) and median overall survival (mOS) of patients in the combination therapy group were higher than those in the chemotherapy alone group [hazard ratio (HR) = 1.152, 95% confidence interval (CI): 0.7848–1.692,
p
= 0.0004, and HR = 1.067, 95% CI: 0.7474–1.524,
p
= 0.0016]. The objective response rate (ORR) of patients in the combination therapy and chemotherapy alone groups was 39.5% (51/129) vs. 27.5% (22/80), and the disease control rate (DCR) between the two groups was 89.9% (116/129) vs. 83.8% (67/80). Univariate analysis revealed the gender, presence of long-term tobacco and alcohol, degree of histological differentiation, serum albumin level, presence of liver metastases, presence of multi-visceral metastases, response, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), glycoprotein antigen 19-9 (CA19-9), systemic inflammatory index (SII), and controlling nutritional status (CONUT) scores were statistically significant with patient prognosis (all
P
values < 0.05). Multi-factor COX regression analysis was continued for the above variables, and the results showed that NLR, MLR, PLR, SII, and CONUT scores were independent influences on patients’ OS (all
p
values < 0.05). A nomogram (C-index 0.77, 95% CI: 0.71–0.84) was created based on these independent influences and later validated using a validation cohort (C-index 0.75, 95% CI: 0.68–0.81). The time-dependent receiver operator characteristic curve (ROC) showed that the area under curve (AUC) of the training cohort patients at 12, 18, and 24 months was 0.72 (95% CI: 0.63–0.81), 0.75 (95% CI: 0.67–0.85), and 0.77 (95% CI: 0.66–0.87) and the AUC of the validation cohort was 0.69 (95% CI: 0.58–0.79), 0.74 (95% CI: 0.65–0.87), and 0.71 (95% CI: 0.64–0.89), respectively. Finally, calibration was performed using calibration curves, and the results showed that nomograms based on inflammatory metrics and CONUT scores could be used to assess survival (12, 18, and 24 months) in patients with advanced BTC treated with ICIs in the first line.
Conclusion
Patients with advanced BTC benefit more from first-line treatment with standard chemotherapy in combination with ICIs than with chemotherapy alone. In addition, nomograms based on inflammatory metrics and CONUT scores can be used to predict survival at 12, 18, and 24 months in patients with advanced BTC treated with ICIs.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37668711</pmid><doi>10.1007/s00262-023-03513-4</doi><tpages>15</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0340-7004 |
| ispartof | Cancer Immunology, Immunotherapy, 2023-11, Vol.72 (11), p.3635-3649 |
| issn | 0340-7004 1432-0851 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10576733 |
| source | SpringerNature Journals; PubMed Central |
| subjects | Biliary tract Biliary tract diseases Cancer Research Chemotherapy Cholangiocarcinoma Disease control Immune checkpoint inhibitors Immunology Immunotherapy Inflammation Leukocytes (neutrophilic) Lymphocytes Medical prognosis Medicine Medicine & Public Health Metastases Metastasis Monocytes Nomograms Nutritional status Oncology Patients Prognosis Sialyl Lewis a antigen Statistical analysis |
| title | Comparison of the effectiveness of chemotherapy combined with immunotherapy and chemotherapy alone in advanced biliary tract cancer and construction of the nomogram for survival prediction based on the inflammatory index and controlling nutritional status score |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-16T00%3A56%3A51IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Comparison%20of%20the%20effectiveness%20of%20chemotherapy%20combined%20with%20immunotherapy%20and%20chemotherapy%20alone%20in%20advanced%20biliary%20tract%20cancer%20and%20construction%20of%20the%20nomogram%20for%20survival%20prediction%20based%20on%20the%20inflammatory%20index%20and%20controlling%20nutritional%20status%20score&rft.jtitle=Cancer%20Immunology,%20Immunotherapy&rft.au=Zhang,%20Zhengfeng&rft.date=2023-11-01&rft.volume=72&rft.issue=11&rft.spage=3635&rft.epage=3649&rft.pages=3635-3649&rft.issn=0340-7004&rft.eissn=1432-0851&rft_id=info:doi/10.1007/s00262-023-03513-4&rft_dat=%3Cproquest_pubme%3E2877034753%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2877034753&rft_id=info:pmid/37668711&rfr_iscdi=true |