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Biological Aging and Survival Outcomes in Patients With Advanced Non-Small Cell Lung Cancer Receiving Systemic
Suguru Kojima1, Yusuke Inoue1, Masato Karayama2
1Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Clinical Lung Cancer
|November 3, 2025
Summary
Biological age, not chronological age, predicts survival in advanced non-small cell lung cancer (NSCLC). Biological age acceleration (BioAgeAccel) offers additional prognostic value, especially with immunotherapy, improving patient stratification for personalized treatment.
Area of Science:
- Oncology
- Biomarkers
- Aging Research
Background:
- Chronological age is insufficient for predicting outcomes in advanced non-small cell lung cancer (NSCLC).
- Biological age (BioAge), derived from clinical biomarkers, may provide superior prognostic information.
- Individual variability in health status and treatment response necessitates advanced predictive markers.
Purpose of the Study:
- To evaluate the prognostic value of Biological Age (BioAge) and BioAge acceleration (BioAgeAccel) in advanced NSCLC patients.
- To compare the predictive power of BioAge and chronological age for overall survival (OS).
- To assess the association of BioAge and BioAgeAccel with immune-related adverse events (irAEs) in patients receiving immune checkpoint inhibitors (ICIs).
Main Methods:
- Retrospective analysis of 138 patients on ICIs and 154 chemotherapy-naïve patients.
- BioAge calculated using chronological age and seven clinical biomarkers; BioAgeAccel defined as residual from BioAge/chronological age regression.
- Survival analyses using Kaplan-Meier and Cox proportional hazards models; competing risk regression for irAEs.
Main Results:
- Higher BioAge independently predicted shorter OS in both ICI and chemotherapy cohorts, unlike chronological age.
- Biologically older patients had significantly worse OS in the ICI cohort.
- BioAgeAccel was an independent prognostic factor for OS in the ICI cohort but not in the chemotherapy cohort.
- No significant associations found between BioAge, BioAgeAccel, chronological age, and irAE risk.
Conclusions:
- Biological age is a robust prognostic factor for advanced NSCLC.
- BioAgeAccel provides additional prognostic value, particularly for patients undergoing immunotherapy.
- Integrating biological age metrics can enhance patient stratification and guide individualized treatment strategies in NSCLC.
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