Baseline and Dynamic Clinical-Laboratory Risk Models for Early Progression or Death During PD-(L)1 Blockade in Advanced NSCLC: Development and Internal Validation.
- 1Department of Medical Oncology, Akdeniz University Faculty of Medicine, 07058 Antalya, Türkiye.
Abstract
Background
We developed clinical-laboratory models for early progression or death within 90 days (EPD90) during PD-1/PD-L1 blockade in advanced non-small cell lung cancer. EPD90 is a pragmatic early-risk endpoint, not a diagnosis of hyperprogressive disease.Methods
This retrospective single-centre cohort included patients treated between January 2018 and March 2026. The four-item baseline score, EPS-4, combined bone metastasis, lactate dehydrogenase (LDH), albumin and C-reactive protein. Among patients alive and progression-free at day 42, D1 added six-week changes in neutrophil-to-lymphocyte ratio (NLR), and D2 additionally included LDH changes. Internal validation used bootstrap resampling and repeated cross-validation.Results
Among 282 patients, 83 (29.4%) had EPD90. In the common baseline complete-case set (n = 252; 76 events), EPS-4 had an apparent area under the curve (AUC) of 0.729 (95% confidence interval [CI] 0.665-0.793). In 238 landmark-eligible complete cases (56 subsequent events), adding NLR change increased AUC from 0.718 to 0.801. Adding LDH yielded an AUC of 0.816, a modest, statistically non-significant increment (delta AUC 0.016; p = 0.094). Bootstrap-corrected calibration slopes were 0.980 for D1 and 0.957 for D2.Conclusions
NLR provided the principal dynamic contribution. D1 is emphasized as the main dynamic model; D2 remains an exploratory extension with uncertain incremental value. Unavailable laboratory collection dates and lack of external validation limit interpretation. The models and proposed thresholds require independent validation before clinical use.
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BibTeX
@article{ozbay2026baseline,
title = {{Baseline and Dynamic Clinical-Laboratory Risk Models for Early Progression or Death During PD-(L)1 Blockade in Advanced NSCLC: Development and Internal Validation.}},
author = {Mehmet Fatih Ozbay and Mehmet Hunur and Sertac Vurgun and Suleyman Alkan and Sema Sezgin Goksu and Mustafa Karaca},
journal = {Current oncology (Toronto, Ont.)},
year = {2026},
month = sep,
doi = {10.3390/curroncol33100593},
url = {https://europepmc.org/article/MED/42930159},
note = {CC BY},
}
RIS
TY - JOUR
TI - Baseline and Dynamic Clinical-Laboratory Risk Models for Early Progression or Death During PD-(L)1 Blockade in Advanced NSCLC: Development and Internal Validation.
AU - Mehmet Fatih Ozbay
AU - Mehmet Hunur
AU - Sertac Vurgun
AU - Suleyman Alkan
AU - Sema Sezgin Goksu
AU - Mustafa Karaca
PY - 2026
DA - 2026/09/30
JO - Current oncology (Toronto, Ont.)
DO - 10.3390/curroncol33100593
UR - https://europepmc.org/article/MED/42930159
AB - Background We developed clinical-laboratory models for early progression or death within 90 days (EPD90) during PD-1/PD-L1 blockade in advanced non-small cell lung cancer. EPD90 is a pragmatic early-risk endpoint, not a diagnosis of hyperprogressive disease.Methods This retrospective single-centre cohort included patients treated between January 2018 and March 2026. The four-item baseline score, EPS-4, combined bone metastasis, lactate dehydrogenase (LDH), albumin and C-reactive protein. Among patients alive and progression-free at day 42, D1 added six-week changes in neutrophil-to-lymphocyte ratio (NLR), and D2 additionally included LDH changes. Internal validation used bootstrap resampling and repeated cross-validation.Results Among 282 patients, 83 (29.4%) had EPD90. In the common baseline complete-case set (n = 252; 76 events), EPS-4 had an apparent area under the curve (AUC) of 0.729 (95% confidence interval [CI] 0.665-0.793). In 238 landmark-eligible complete cases (56 subsequent events), adding NLR change increased AUC from 0.718 to 0.801. Adding LDH yielded an AUC of 0.816, a modest, statistically non-significant increment (delta AUC 0.016; p = 0.094). Bootstrap-corrected calibration slopes were 0.980 for D1 and 0.957 for D2.Conclusions NLR provided the principal dynamic contribution. D1 is emphasized as the main dynamic model; D2 remains an exploratory extension with uncertain incremental value. Unavailable laboratory collection dates and lack of external validation limit interpretation. The models and proposed thresholds require independent validation before clinical use.
SN - 1198-0052
SN - 1718-7729
ER -