Construction and validation of a risk prediction model for severe myelosuppression in lung cancer patients undergoing chemotherapy

doi:10.19983/j.issn.2096-8493.20262040

Abstract

Abstract:

Objective: To explore the risk factors associated with severe myelosuppression in lung cancer patients receiving chemotherapy and to develop a risk prediction model for severe myelosuppression in these patients. Methods: A retrospective analysis was performed on the relevant data of 145 lung cancer patients who experienced myelosuppression following chemotherapy during their hospitalization at Guangzhou Chest Hospital from September 2023 to December 2024.The risk factors contributing to severe myelosuppression were systematically analyzed. Results: Among 145 lung cancer patients with myelosuppression following chemotherapy, 48 cases (33.1%) developed severe myelosuppression. Spearman correlation analysis revealed that severe myelosuppression was significantly positively correlated with the history of pulmonary surgery and platinum-containing chemotherapy regimens, and was negatively correlated with body mass index (BMI), chemotherapy cycles, pre-chemotherapy red blood cell count, hemoglobin level, platelet count, serum albumin level, and gamma-glutamyl transferase. Multivariate regression analysis showed that noninitial chemotherapy was a protective factor against severe myelosuppression in patients with lung cancer undergoing chemotherapy (OR=0.069,95%CI:0.019-0.246), while decreased serum albumin level (OR=10.789,95%CI:4.012-29.015) and history of pulmonary surgery (OR=3.193,95%CI:1.173-8.695) were independent risk factors for severe myelosuppression in these patients. A logistic regression model was established and the predictive efficacy of the model was verified via the area under the ROC curve, which was 0.839 (95% confidence interval (CI): (0.775-0.903) of the final model, with the maximum Youden index 0.566, the sensitivity 81.3%, and the specificity 75.3%. Conclusion: This model exhibits excellent predictive performance and can serve as a valuable reference for clinical treatment and nursing interventions to prevent severe myelosuppression.

Key words: Lung neoplasms, Drug therapy, Bone marrow, Serum albumin, Forecasting

CLC Number:

Liu Suling, Chen Hua, Ding Wenping, Wang Fan. Construction and validation of a risk prediction model for severe myelosuppression in lung cancer patients undergoing chemotherapy[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(5): 615-623. doi: 10.19983/j.issn.2096-8493.20262040

Figures/Tables 7

因素	轻度骨髓抑制组 (97例)	重度骨髓抑制组 (48例)	统计检验值	P值	因素	轻度骨髓抑制组 (97例)	重度骨髓抑制组 (48例)	统计检验值	P值
年龄(岁,$\bar{x}±s$)	62.39± 8.93	62.33± 7.14	t=0.039	0.969	并发其他疾病[例,构成比(%)]			χ²=3.066	0.080
性别[例,构成比(%)]			χ²=0.011	0.915	有	94(96.9)	43(89.6)
男性	74(76.3)	37(77.1)			无	3(3.1)	5(10.4)
女性	23(23.7)	11(22.9)			化疗途径[例,构成比(%)]			χ²=3.797	0.051
文化程度[例,构成比(%)]			χ²=0.004	0.951	外周静脉	51(52.6)	17(35.4)
小学及以下	47(48.5)	23(47.9)			中心静脉	46(47.4)	31(64.6)
中学及以上	50(51.5)	25(52.1)			病理类型[例,构成比(%)]			χ²=10.503	0.015
支付形式[例,构成比(%)]			χ²=4.526	0.033	腺癌	33(34.0)	15(31.3)
医保	95(97.9)	43(89.6)			鳞癌	36(37.1)	28(58.3)
自费	2(2.1)	5(10.4)			小细胞癌	23(23.7)	5(10.4)
体质量指数[例,构成比(%)]			χ²=10.473	0.001	其他^a	5(5.2)	0(0.0)
正常	60(61.9)	16(33.3)			化疗方案[例,构成比(%)]			χ²=4.129	0.042
异常	37(38.1)	32(66.7)			含铂类	56(57.7)	36(75.0)
吸烟史[例,构成比(%)]			χ²=0.093	0.761	不含铂类	41(42.3)	12(25.0)
有	24(24.7)	13(27.1)			化疗周期[例,构成比(%)]			χ²=16.288	<0.001
无	73(75.3)	35(72.9)			首次	6(6.2)	15(31.2)
饮酒史[例,构成比(%)]			χ²=0.411	0.522	非首次	91(93.8)	33(68.8)
有	16(16.5)	10(20.8)			肺癌分期[例,构成比(%)]			χ²=0.970	0.325
无	81(83.5)	38(79.2)			Ⅰ~Ⅲ期	32(33.0)	12(25.0)
高血压病史[例,构成比(%)]			χ²=0.856	0.355	Ⅳ期	65(67.0)	36(75.0)
有	5(5.2)	1(2.1)			白细胞计数[例,构成比(%)]			χ²=0.847	0.357
无	92(94.8)	47(97.9)			正常	68(70.1)	30(62.5)
冠心病史[例,构成比(%)]			χ²=0.108	0.742	降低	29(29.9)	18(37.5)
有	3(3.1)	2(4.2)			中性粒细胞计数[例,构成比(%)]			χ²=0.013	0.910
无	94(96.9)	46(95.8)			正常	76(78.4)	38(79.2)
肺部手术史[例,构成比(%)]			χ²=6.100	0.014	降低	21(21.6)	10(20.8)
有	23(23.7)	21(43.8)			血红蛋白[例,构成比(%)]			χ²=2.560	0.110
无	74(76.3)	27(56.2)			正常	28(28.9)	8(16.7)
糖尿病史[例,构成比(%)]			χ²=2.287	0.130	降低	69(71.1)	40(83.3)
有	14(14.4)	3(62.7)			血小板计数[例,构成比(%)]			χ²=1.900	0.168
无	83(85.6)	45(9.3)			正常	90(92.8)	47(97.9)
脑梗死病史[例,构成比(%)]			χ²=0.807	0.369	降低	7(7.2)	1(2.1)
有	1(1.0)	0(0.0)			血清白蛋白水平[例,构成比(%)]			χ²=25.166	<0.001
无	96(99.0)	48(100.0)			正常	74(76.3)	16(33.3)
乙型肝炎[例,构成比(%)]			χ²=9.286	0.002	降低	23(23.7)	32(66.7)
有	11(11.3)	0(0.0)			γ-谷氨酰基转移酶[例,构成比(%)]			χ²=0.279	0.597
无	86(88.7)	48(100.0)			正常	51(52.6)	23(47.9)
					升高	46(47.4)	25(52.1)

References 20

[1]	Wang X, Gu S, Wen J, et al. Association between chemotherapy-induced myelosuppression and curative efficacy of 2-cycle chemotherapy in small cell lung cancer[J]. Cancer Chemother Pharmacol, 2024, 93(2):151-159. doi:10.1007/s00280-023-04608-6.
[2]	王宁, 王宝华. 全球肺癌负担防治现况与展望[J]. 结核与肺部疾病杂志, 2025, 6(3):256-260. doi:10.19983/j.issn.2096-8493.20250048.
[3]	杭冲, 房楠楠, 刘晓. 叙事护理联合阶段性健康教育在非小细胞肺癌化疗患者护理中的应用观察[J]. 结核与肺部疾病杂志, 2024, 5(4):339-344. doi:10.19983/j.issn.2096-8493.2024074.
[4]	Crawford J, Herndon D, Gmitter K, et al. The impact of myelosuppression on quality of life of patients treated with chemotherapy[J]. Future Oncol, 2024, 20(21):1515-1530. doi:10.2217/fon-2023-0513.
[5]	Dong Y, Hu C, Liu J, et al. Construction of an auxiliary scoring model for myelosuppression in patients with lung cancer chemotherapy based on random forest algorithm[J]. Am J Transl Res, 2023, 15(6): 4155-4163. pmid: 37434857
[6]	Li Y, Bao Y, Zheng H, et al. A nomogram for predicting severe myelosuppression in small cell lung cancer patients following the first-line chemotherapy[J]. Sci Rep, 2023, 13(1):17464. doi:10.1038/s41598-023-42725-7.
[7]	Kamimura K, Matsumoto Y, Zhou Q L, et al. Myelosuppression by chemotherapy in obese patients with gynecological cancers[J]. Cancer Chemother Pharmacol, 2016, 78(3): 633-641. doi:10.1007/s00280-016-3119-2.
[8]	Huang H, Liu J, Xiao Q, et al. GWAS study of myelosuppression among NSCLC patients receiving platinum-based combination chemotherapy[J]. Acta Biochim Biophys Sin (Shanghai), 2025, 57(8): 1281-1291. doi:10.3724/abbs.2025013.
[9]	单静怡, 朱凌宇, 顾贤. 肺癌化疗患者 RET、Cr/CysC、Nrf2mRNA 水平变化及预测骨髓抑制的价值[J]. 现代肿瘤医学, 2022, 30 (12):2186-2190. doi:10.3969/j.issn.1672-4992.2022.12.015.
[10]	Li X, Li L, Zhang L. Development and validation of a prediction model for myelosuppression in lung cancer patients after platinum-based doublet chemotherapy: a multifactorial analysis approach[J]. Am J Cancer Res, 2025, 15(2):470-486. doi:10.62347/TFUC2568. pmid: 40084374
[11]	Kuderer N M, Dale D C, Crawford J, et al. Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review[J]. J Clin Oncol, 2007, 25(21):3158-3167. doi:10.1200/JCO.2006.08.8823. pmid: 17634496
[12]	朱思遥, 王赛斌. 肺癌化疗后骨髓抑制研究进展[J]. 临床医学研究与实践, 2024, 9(9):195-198. doi:10.19347/j.cnki.2096-1413.202409048.
[13]	李晓黎, 吴坤荣, 尹影, 等. 奈达铂致肺癌患者骨髓抑制的危险因素研究[J]. 药物不良反应杂志, 2020, 22 (4): 239-246. doi:10.3760/cma.j.cn114015-20190327-00292.
[14]	王茂泽, 陈山, 陈亚红, 等. 老年肺癌化疗患者骨髓抑制发生及影响因素[J]. 中国老年学杂志, 2021, 41(10):2209-2212. doi:10.3969/j.issn.1005-9202.2021.10.054.
[15]	王菁菁, 刘丽改, 谢雯. 血清白蛋白生理功能再认识[J]. 临床肝胆病杂志, 2025, 41(3): 404-408. doi:10.12449/JCH250302.
[16]	陈丽. 老年肺癌化疗患者发生骨髓抑制的危险因素分析及风险预测模型构建[D]. 南京: 江苏大学, 2021. doi:10.27170/d.cnki.gjsuu.2021.002709.
[17]	彭文. 晚期非小细胞肺癌患者化疗后发生重度骨髓抑制的影响因素分析[D]. 南昌: 南昌大学, 2019.
[18]	陈丽, 邹圣强, 江竹月, 等. 老年肺癌化疗患者骨髓抑制风险预测模型的构建与验证[J]. 中华现代护理杂志, 2021, 27(14):1848-1853. doi:10.3760/cma.j.cn115682-20200831-05137.
[19]	王合法, 闫光辉, 杨召锋. 非小细胞肺癌化疗患者骨髓抑制发生状况及其影响因素[J]. 广州医药, 2023, 54(2):61-63,78. doi:10.3969/j.issn.1000-8535.2023.02.012.
[20]	高小月, 周彩存, 顾芬, 等. 初次确诊非小细胞肺癌患者首次化疗后骨髓抑制危险因素的前瞻性研究[J]. 同济大学学报(医学版), 2018, 39(6):102-107. doi:10.16118/j.1008-0392.2018.06.020.

指标	0度	Ⅰ度	Ⅱ度	Ⅲ度	Ⅳ度
白细胞计数(×10⁹/L)	≥4.0	3.0~3.9	2.0~2.9	1.0~1.9	<1.0
中性粒细胞计数(×10⁹/L)	≥2.0	1.5~1.9	1.0~1.4	0.5~0.9	<0.5
血红蛋白(g/L)	≥110	95~109	80~94	65~79	<65
血小板计数(×10⁹/L)	≥100	75~99	50~74	25~49	<25

分级	例数	构成比(%)
Ⅰ度	64	44.1
Ⅱ度	33	22.8
Ⅲ度	38	26.2
Ⅳ度	10	6.9

自变量	赋值
支付形式	医保=0,自费=1
体质量指数	正常=0,降低=1
乙型肝炎病史	否=0,是=1
肺部手术史	否=0,是=1
化疗方案	不含铂类=0,含铂类=1
化疗周期	首次=0,非首次=1
化疗前血清白蛋白水平	正常=0,降低=1
病理类型	以其他为参照设置哑变量,X1=鳞癌(0,1),X2=腺癌(0,1),X3=小细胞(0,1),X3=其他类型(0,1)

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI值
常数项	0.563	0.685	0.675	0.411	1.756	-
肺部手术史	1.161	0.511	5.159	0.023	3.193	1.173~8.695
非首次化疗	-2.672	0.647	17.071	<0.001	0.069	0.019~0.246
化疗前低血清白蛋白水平	2.379	0.505	22.207	<0.001	10.789	4.012~29.015