# Evaluation of six clinical prognostic scores in NSCLC patients undergoing first line chemoimmunotherapy

## TL;DR

This study compares six scoring systems to predict outcomes in non-small cell lung cancer patients treated with first-line chemoimmunotherapy.

## Contribution

The study evaluates and compares the performance of six clinical prognostic scores in the context of chemoimmunotherapy for NSCLC.

## Key findings

- The RMH score had the highest C-indices for both overall and progression-free survival.
- MDACC and MDACC+NLR also showed strong performance in predicting survival outcomes.
- Only MDACC remained statistically significant for overall survival after FDR correction.

## Abstract

The study aimed to evaluate the effectiveness of six prognostic scores for predicting the outcomes to first-line chemoimmunotherapy (CIT) in non-small cell lung cancer (NSCLC) patients.

NSCLC patients receiving first-line CIT were included. The prognostic scores evaluated were RMH, MDACC, MDACC+NLR, MDA-ICI, LIPI, and GRIm. Survival curves were generated using the Kaplan–Meier method, and univariate and multivariate analyses were conducted via the Cox proportional hazards regression model. The C−index and time−dependent AUC were calculated to comprehensively quantify and compare the predictive performance of each system. The Log−rank test and False Discovery Rate (FDR) correction was employed to compare survival outcomes across different risk groups defined by the six prognostic scoring systems.

A cohort of 298 NSCLC patients was analyzed. The median overall survival (mOS) of patients receiving first-line CIT was 36.5 months (95%CI: NE-NE), and the median progression-free survival (mPFS) was 14.5 months (95%CI: 11.9-17.1). Multivariate analysis showed that bone metastasis (P = 0.042), and more than two metastatic sites (P = 0.031) as independent predictors of poor OS. In quantitative performance comparison, RMH achieved the highest C-indices for both OS (0.672, 95%CI: 0.531-0.813) and PFS (0.652, 0.564-0.737); MDACC also performed well, with C-indices for OS (0.651, 0.564-0.737) and PFS (0.615, 0.554-0.738). Time-dependent AUC analysis showed that MDA-ICI attained the highest 1-year OS and PFS AUC (0.630 and 0.592), followed by the MDACC+NLR (0.600 and 0.571). Based on log-rank testing and following FDR correction, only the MDACC maintained a statistically significant association with OS (high-risk 14.0 vs. intermediate-risk 34.6 vs. low-risk NR months; P = 0.003, Q = 0.036). For PFS, the MDACC+NLR score showed a marginal significance after FDR correction (Q = 0.054).

The RMH, MDACC, and MDACC+NLR scoring systems all demonstrate prognostic utility in the NSCLC patients treated with first-line CIT, and the optimal choice among them may depend on the specific clinical context and the outcome metric of primary interest.