Inflammation-nutrition biomarker model for survival prediction in lung cancer patients with concurrent tuberculosis

To explore the prognostic value of eight inflammation-nutrition biomarkers in patients with lung cancer and tuberculosis as no multidimensional prognostic models for this comorbid population are available currently.

A retrospective study included 100 patients with lung cancer and tuberculosis admitted to a tertiary hospital from October 2019 to October 2024. Eight inflammation-nutrition markers (NLR, PLR, SII, LMR, PNI, HALP, HRR, ALB/GLB) were chosen as predictors while overall survival (OS) was the major event. Feature selection was implemented by LASSO regression; a Cox proportional hazards model was established afterwards. The nomogram's performance was assessed by ROC curve and C-index as well as the calibration using bootstrap resampling. The statistical power was calculated by PowerSurvEpi and sensitivity analyses were implemented to test the robustness of the model.

There were six predictors remaining in the final model including diabetes, ECOG PS, NLR, PNI, HRR and RDW. Among them, ECOG PS was an independent prognostic factor (HR = 1.76, p = 0.04). The nomogram achieved a good performance (C-index = 0.71), an AUC of 0.693 for 3-year OS as well as an excellent calibration (Bootstrap P > 0.05). In the high-risk subgroup with ECOG PS ≥ 2 and NLR>8, the 5-year survival rate was close to zero. The model achieved an adequate statistical power (83%, α = 0.05). Sensitivity analysis revealed an significant interaction between ECOG PS and NLR (p = 0.032) and NLR>8 was the most robust threshold for this interaction.

This is the first study to establish and validate a combined inflammation-nutrition prognostic model for patients with lung cancer and tuberculosis. Our model provides a quantitative tool to stratify individual risk and offers evidence for the usage of nutritional interventions in high-risk patients.