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Impact of effective dose to immune cells (EDIC) on survival in limited-stage small cell lung cancer treated with radiotherapy and immunotherapy
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DOI：10.21037/tlcr-2025-1-1452.png)
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Abstract
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Background: Concurrent chemoradiotherapy-immunotherapy is promising for limited-stage small cell lung cancer (LS-SCLC), but biomarkers integrating local and systemic immunity are needed. This study evaluates the prognostic value of combining effective dose to immune cells (EDIC) with hematological indicators in these patients. Methods: In this retrospective cohort study of 174 LS-SCLC patients receiving radiotherapyimmunotherapy, we collected clinical data, pre-radiotherapy hematological indices, and dosimetric parameters. EDIC was calculated using an established model. Prognostic cutoffs were determined by receiver operating characteristic (ROC) analysis, and survival outcomes were assessed via Kaplan-Meier and Cox regression methods. Results: ROC analysis established prognostic cutoffs for EDIC and hematological indices. EDIC demonstrated the highest predictive efficacy [progression-free survival (PFS)-area under the curve (AUC): 0.681; overall survival (OS)-AUC: 0.731], followed by platelet-to-lymphocyte ratio (PLR) among hematological markers (PFS-AUC: 0.659; OS-AUC: 0.630). The combination of EDIC and PLR significantly outperformed either marker alone. Survival analysis revealed that the low EDIC group had significantly better median PFS (not reached vs. 35 months, P<0.001) and OS (not reached vs. 48 months, P=0.001) compared to the high EDIC group; similarly, the low PLR group showed significantly superior median PFS (51 vs. 26 months, P=0.002) and OS (54 vs. 36 months, P=0.002). Multivariate Cox regression analysis confirmed that high EDIC [PFS-HR =2.270, 95% confidence interval (CI): 1.290-3.994, P=0.004; OS-HR =2.352, 95% CI: 1.370-4.038, P=0.002] and high PLR (PFS-HR =1.777, 95% CI: 1.024-3.081, P=0.04; OS-HR =2.407, 95% CI: 1.382-4.190, P=0.002) were independent risk factors for PFS and OS. Importantly, the combined EDIC-PLR risk model showed strong prognostic discrimination. For PFS, median values were not reached, 30, and 25 months for the low-risk, intermediate-risk, and high-risk groups, respectively (P<0.001). For OS, median values were not reached, 44, and 22 months, with significant pairwise differences between all groups. Conclusions: Our findings demonstrate that a risk stratification model integrating EDIC and PLR effectively discriminates prognostic outcomes in LS-SCLC patients receiving combined radiotherapy and immunotherapy, with low EDIC and low PLR correlating with superior survival.
Keywords:
Small cell lung cancer (SCLC)
radiotherapy
immunotherapy
effective dose to immune cells (EDIC)
platelet-to-lymphocyte ratio (PLR)
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