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Updated: Apr 24, 2026
Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Prognostic analysis and development of a prognostic model for EML4-ALK-positive lung cancer patients treated with
Ruimin Liu1, Chunrong Su1, Hang Su2
1Oncology Department of Integrated Traditional Chinese and Western Medicine, Zhumadian Central Hospital (Zhumadian Central Hospital Affiliated to Huanghuai College), Zhumadian, Henan, China.
Objective:
This study aimed to investigate prognostic factors and establish prognostic models for EML4-ALK-positive non-small cell lung cancer (NSCLC) patients receiving ALK tyrosine kinase inhibitors (TKIs) treatment.
Methods:
We retrospectively analyzed 114 ALK-positive NSCLC patients treated at our institution from January 2020 to January 2024. Clinical data, laboratory results, imaging findings, and follow-up records were collected. Progression-free survival (PFS) and overall survival (OS) served as primary endpoints. Statistical methods included Kaplan-Meier analysis, Cox regression modeling, and nomogram construction (70% training set, 30% validation cohort). Model performance was evaluated using Harrell's C-index, calibration curves, and time-dependent receiver operating characteristic (ROC) analysis.
Results:
The median PFS was 30.97 months (95% CI: 25.43-36.52), while median OS was not reached. Multivariate analysis identified four independent PFS predictors: brain metastasis (HR = 2.15, p = 0.008), central lesion location (HR = 1.89, p = 0.013), tumor diameter >3 cm (HR = 1.76, p = 0.022), and lymphocyte-to-monocyte ratio ≤2.26 (HR = 1.92, p = 0.011). For OS, significant factors included brain metastasis (HR = 2.87, p = 0.002), CYFRA21-1 level (HR = 1.65, p = 0.028), and LMR (HR = 2.04, p = 0.007). The developed nomograms demonstrated good prognostic accuracy, with validation cohort C-indices of 0.73 (PFS) and 0.75 (OS). Time-dependent AUCs for 3-year PFS and 4-year OS prognostic were 0.79 and 0.78, respectively.
Conclusion:
Our study established that brain metastasis status, tumor characteristics, and systemic inflammatory markers significantly impact clinical outcomes in ALK-positive NSCLC patients undergoing TKI therapy. The developed prognostic models show satisfactory prognostic performance and may assist in clinical decision-making and patient stratification. These findings warrant further validation in prospective, multicenter studies.
