1. A construction method for constructing a non-small cell lung cancer immune checkpoint inhibition treatment efficacy prediction model based on organ transfer spectrum is characterized by comprising the following steps:

s1, evaluating and comparing the influence of different baseline transfer organs in an OAK queue on OS and PFS of patients in an attuzumab group and a docetaxel group;

s2, evaluating and comparing the prediction effect of the metastatic organ spectrums of different PD-L1 expression level layers of the attlizumab group and the docetaxel group in the OAK queue;

s3, evaluating and comparing OS of different transfer organ types and quantities of an astuzumab group and a docetaxel group in a PD-L1 positive OAK queue;

and S4, establishing a scoring system METscore based on the organ transfer spectrum, performing multivariate Cox proportion risk regression, and predicting the clinical result of ICI treatment by calculating the total score of the prognosis effect and the prediction effect.

2. The method for constructing a model for predicting the therapeutic effect of non-small cell lung cancer immune checkpoint inhibition based on organ metastasis profiles as claimed in claim 1, wherein the model incorporates organ metastasis states, treatment groups and interaction terms between each organ and treatment, and performs multivariate Cox proportional hazards regression.

3. The method for constructing a model for predicting the curative effect of non-small cell lung cancer immune checkpoint inhibition therapy based on organ metastasis profiles as claimed in claim 1, wherein the input variables of the model are seven binary variables, 0 represents no metastasis and 1 represents metastasis, and the variables are ADRENAL, BRAIN, LIVER, BONE, PEFF, PLEURA and MEDIA respectively.

4. The method for constructing a model for predicting the curative effect of non-small cell lung cancer immune checkpoint inhibition therapy based on organ metastasis spectrum according to claim 1, wherein the equation of the model is as follows:

(ii) a prognosis score of 3 × ADRENAL +2 × brake +5 × LIVER +1 × BONE +1 × PEFF +0 × PLEURA +0 × MEDIA;

the prediction score (-5) × ADRENAL + (-5) × brake + (-3) × LIVER +1 × BONE +2 × PEFF +0 × plain +1 × MEDIA;

METscore ═ prognostic score + predictive score.

5. The method for constructing a prediction model of therapeutic effect of non-small cell lung cancer immune checkpoint inhibition based on organ metastasis profiling according to claim 1, wherein the optimum cutoff value of METscore is 3.

6. The method for constructing a prediction model of curative effect of non-small cell lung cancer immune checkpoint inhibition therapy based on organ metastasis spectrum as claimed in claim 5, wherein the model classifies METscore according to cut-off value (≧ 3vs <3) and gets the category to which the patient belongs:

if the total score is more than or equal to 3, the group is classified as METscore-High group;

if the total score is less than 3, the score is classified as METscore-Low group.

The immunotherapy curative effect of the METscore-Low group NSCLC patients is obviously better than that of the METscore-High group patients.

7. A prediction model obtained by the method for constructing the non-small cell lung cancer immune checkpoint inhibition treatment result prediction model based on organ metastasis spectrums according to claims 1 to 6.

8. Use of the predictive model of claim 7 in a non-small cell lung cancer dosing guide.

Background

Immune Checkpoint Inhibitors (ICI), represented by the monoclonal antibodies programmed cell death protein-1 (PD-1) or programmed cell death ligand 1(PD-L1), have changed the mode of treatment and are the primary treatment for advanced or metastatic non-small cell lung cancer (NSCLC). Although immunotherapy has been successful over chemotherapy in the past decade, the blockade of PD- (L)1 has been far from inducing a durable immune response for every patient in all non-screened NSCLC populations, even in the PD-L1 positive population, and there is a pressing need for reliable immunotherapeutic predictors to facilitate accurate medicine.

The effectiveness of ICI therapy is related to the biological properties of the tumor microenvironment at different anatomical locations. According to a logical extension of this concept, it is envisaged that the heterogeneity of immunotherapy efficacy in the metastatic environment may depend on the interaction of the global anti-tumor immunity with the local metastatic organ microenvironment. Preliminary evidence suggests that the survival prospects of non-small cell lung cancer patients receiving ICI therapy are inversely correlated with distant metastasis (e.g., liver metastasis). However, these studies were performed in the single arm environment of ICI, and comparison of control groups lacking conventional therapy (e.g. chemotherapy) resulted in no way of distinguishing between immunotherapy-specific predictions or treatment-independent prognostic effects. Furthermore, previous studies of the therapeutic impact of each metastatic organ were isolated and therefore lack comprehensive analysis focusing on global and encompassing the entire metastatic pattern; since tumors of patients with advanced cancer may spread to multiple organs simultaneously, the clinical significance of the outcome studies focusing on a single metastatic organ is limited.

The role of the metastatic organs in affecting the efficacy of immunotherapy remains unclear. Therefore, a prediction model of the curative effect of the non-small cell lung cancer immune check point inhibition therapy based on the organ transfer spectrum is established, and the model has great significance for auxiliary immunotherapy and personalized medicine.

Disclosure of Invention

In view of the above problems, the present invention aims to provide a method for constructing a prediction model for predicting the therapeutic effect of non-small cell lung cancer immune checkpoint inhibition based on organ metastasis profiles.

In order to achieve the purpose, the technical scheme provided by the invention is as follows:

the model for predicting the curative effect of non-small cell lung cancer immune checkpoint inhibition therapy based on organ transfer spectrum relates to 2062 patients with advanced NSCLC receiving ICI treatment, wherein the model comprises 850 patients in OAK stage III test (OAK cohort), 136 patients in FIR stage II test (FIR cohort), 667 patients in BIRCH stage II test (BIRCH cohort) and 409 patients in southern university hospital of medical science (called NFyy-ICI cohort), and the construction method comprises the following steps:

s1, evaluating the influence of different baseline transfer organs in an OAK queue on OS and PFS of patients in an attuzumab group and a docetaxel group;

s2, evaluating and comparing the prediction effect of the metastatic organ spectrums layered according to different PD-L1 expression levels of an astuzumab group and a docetaxel group in OAK;

s3, evaluating and comparing OS of different transfer organ types and quantities of the astuzumab group and the docetaxel group in the PD-L1 positive OAK queue.

And S4, establishing a scoring system METscore based on the organ transfer spectrum, performing multivariate Cox proportion risk regression, and predicting the clinical result of ICI treatment by calculating the total score of the prognosis effect and the prediction effect.

As a preferred embodiment of the invention, the model incorporates organ metastasis status, treatment groups, and interaction terms between individual organs and treatments, and performs multivariate Cox proportional hazards regression.

As a preferred embodiment of the present invention, the input variables of the model are seven two classes, 0 for no metastasis, 1 for metastasis, and the variables are ADRENAL (ADRENAL gland), BRAIN (BRAIN), LIVER (LIVER), BONE (BONE), PEFF (pleural effusion), PLEURA (pleural), MEDIA (mediastinum), respectively.

As a preferred embodiment of the present invention, the equation of the model is:

the prognosis score is 3 × ADRENAL +2 × BRAIN +5 × LIVER +1 × BONE +1 × PEFF +0 × PLEURA +0 × MEDIA.

The prediction score (-5) × ADRENAL + (-5) × brake + (-3) × LIVER +1 × BONE +2 × PEFF +0 × plain +1 × MEDIA.

METscore ═ prognostic score + predictive score.

As a preferred embodiment of the invention, the model also includes the use of Nomogram plots showing normalized scores for the prognostic effect and immunotherapy-specific predicted effect for each metastatic organ, as well as METscore as a total score for predicting the ultimate survival of patients after ICI treatment.

As a preferred embodiment of the present invention, the model further comprises determining a cutoff value of METscore corresponding to 3 obtained by the maximum selected rank statistic by weighing the survival benefit against the minimum ratio of each group.

As a preferred embodiment of the invention, the model further comprises a binary classification of METscore by cutoff value (≧ 3vs <3) and outputting the class to which it belongs:

if the total score is more than or equal to 3, the score is classified as METscore-High group.

If the total score is less than 3, the score is classified as METscore-Low group.

As a preferred embodiment of the present invention, the model is further included inhttps://metscore- ici.github.io/Pages/The above provides a Web-based METscore computing tool.

The invention also provides a prediction model obtained by the construction method of the non-small cell lung cancer immune checkpoint inhibition treatment result prediction model based on the organ transfer spectrum.

In addition, the invention also provides application of the prediction model in non-small cell lung cancer medication guidance.

Compared with the prior art, the invention has the beneficial effects that:

the invention provides a construction method of a non-small cell lung cancer immune checkpoint inhibition treatment result prediction model, describes the immune treatment prediction and prognosis effects of a metastatic organ spectrum of a patient with advanced NSCLC in a PD-L1 dependent mode, and is helpful for improving the understanding of organ-specific anti-tumor immunity in tumor immune treatment. Importantly, the metastasis-based scoring system combines prediction and prognostic impact of metastatic organ profiles to enable non-invasive prediction of the final outcome after ICI treatment in PD-L1 positive non-small cell lung cancer patients by baseline imaging.

Drawings

FIG. 1 is a flow chart of the research of the construction method of the non-small cell lung cancer immune checkpoint inhibition treatment outcome prediction model of the present invention.

Fig. 2 is a Kaplan-Meier plot and a comparison graph of OS and PFS of different metastatic organ populations based on the attritumab group and the docetaxel group, wherein a is a Kaplan-Meier curve of OS of the attritumab group, B is a Kaplan-Meier curve of OS of the docetaxel group, C is an OS comparison graph of the attritumab group and the docetaxel group, D is a Kaplan-Meier curve of PFS of the attritumab group, E is a Kaplan-Meier curve of PFS of the docetaxel group, and F is a PFS comparison graph of the attritumab group and the docetaxel group.

FIG. 3 is a forest plot of OS in different metastatic organ classes in populations (A) total, (B) PD-L1 positive (TC/IC ≧ 1%) and (C) PD-L1 negative (TC/IC < 1%) based on the attrituximab group versus the docetaxel group.

Fig. 4 is a Kaplan-Meier plot of OS for the attrituximab group and docetaxel group that were PD-L1 positive based on different numbers of organ metastases, where a is the Kaplan-Meier plot of OS for the attrituximab group and docetaxel group that were PD-L1 positive without class I organ metastases, B is the Kaplan-Meier plot of OS for the attrituximab group and docetaxel group that were PD-L1 positive with single class I organ metastases, and C is the Kaplan-Meier plot of OS for the attrituximab group and docetaxel group that were PD-L1 positive with two class I organ metastases.

Fig. 5 is a Kaplan-Meier plot of OS based on different class I metastatic organ numbers of the PD-L1 positive attrituzumab group and the docetaxel group, wherein a is a Kaplan-Meier plot of OS based on different class I metastatic organ numbers of the PD-L1 positive attrituzumab group, and B is a Kaplan-Meier plot of OS based on different class I metastatic organ numbers of the PD-L1 positive docetaxel group.

FIG. 6 is a Nomogram of a method for constructing a model for predicting the outcome of non-small cell lung cancer immune checkpoint inhibition therapy according to the present invention.

FIG. 7 is a METscore calculation tool for a version of a webpage designed in accordance with the present invention.

FIG. 8 is a Kaplan-Meier plot of OS of different METscores in PD-L1 positive populations based on OAK, FIR, BIRCH, NFyy-ICI, where A is the Kaplan-Meier curve of OS of different METscores in the atlas group of attuzumab in the OAK cohort, B is the Kaplan-Meier curve of OS of different METscores in the docetaxel group of the OAK cohort, C is the Kaplan-Meier curve of OS of different METscores in the atlas group of attuzumab in the FIR cohort, D is the Kaplan-Meier curve of OS of different METscores in the atlas group of attuzumab in the BIRCH cohort, and E is the Kaplan-Meier curve of OS of different METscores in the ATyy-ICI cohort of the NFyy-ICI cohort.

FIG. 9 is a Kaplan-Meier plot of OS and PFS of different METscores after receiving first-line immunotherapy in a population screened with PD-L1 based on FIR, BIRCH, and NFyy-ICI, where A is the Kaplan-Meier curve of OS of different METscores receiving first-line immunotherapy in FIR, BIRCH cohort, B is the Kaplan-Meier curve of PFS of different METscores receiving first-line immunotherapy in FIR, BIRCH cohort, C is the Kaplan-Meier curve of OS of different METscores receiving first-line immunotherapy in NFyy-ICI cohort, and D is the Kaplan-Meier curve of PFS of different METscores receiving first-line immunotherapy in NFyy-ICI cohort.

Detailed Description

For better illustrating the objects, technical solutions and advantages of the present invention, the present invention will be further described with reference to the accompanying drawings and specific embodiments.

Example 1

Construction method of non-small cell lung cancer immune check point inhibition treatment result prediction model

2062 patients with advanced NSCLC who received ICI therapy were selected, including 850 patients from OAK phase III trials (OAK cohort), 136 patients from FIR phase II trials (FIR cohort), 667 patients from BIRCH phase II trials (BIRCH cohort), and 409 patients from southern hospital of southern university of medical science (NFyy-ICI cohort), both from the attritumab and docetaxel cohorts screened by PD-L1, in the OAK cohort, according to the policies and procedures of Roche clinical study data sharing and approval of the southern hospital institutional review board, the FIR cohort, the BIRCH cohort, and the NFyy-ICI cohort were treated with at least one dose of ICI as first-line or follow-up regimen.

The baseline PD-L1 status of the three cohorts (OAK, FIR, BIRCH) was examined using the SP142 antibody and scored according to the percentage of tumor cells (TC0: < 1%; TC1: > 1% and < 5%; TC2: > 5% and < 50%; TC3: > 50%) or tumor-infiltrating immune cells (IC0: < 1%; IC1: < 1% and < 5%; IC2: > 5% and < 10%; IC3: > 10%) by PD-L1 staining. Expression of PD-L1 in the real world cohort (NFyy-ICI) was detected using the 22C3 antibody before treatment and the Tumor Proportion Score (TPS) was calculated. Immunohistochemical detection of patients with at least 1% of tumor cells or immune cells PD-L1 or TPS was positive. In these cohorts, 465 patients from OAK and 367 patients from NFyy-ICI were tested positive for PD-L1, while patients from both the PD-L1 screened FIR and BICH tests were confirmed positive at enrollment.

In the present invention, the pretreated metastatic organ spectrum includes metastatic states of adrenal glands, brain, liver, pleura, pleural effusion and mediastinum.

The research flow of the invention is shown in figure 1, and the specific process is as follows: first, the predictive and prognostic effect of distant metastasis in metastatic organ spectra was found by the two-arm OAK cohort (attrituximab group and docetaxel group). Next, a metastasis-based scoring system, called METscore, was developed to predict the clinical outcome of ICI treatment by combining the predicted and prognostic effects of each metastatic organ to calculate an overall score. Finally, validation was performed in the attrituximab cohort (FIR and BIRCH), the real world immunotherapy cohort (NFyy-ICI) and the first line of immunotherapy cohort (NFyy-ICI, FIR and BIRCH) selected by PD-L1.

(1) Specific predictive Effect of metastatic organ Spectrum on ICI treatment

In order to describe the predicted effect of metastatic organ spectra on ICI treatment, the effect of metastatic organ spectra on survival outcome was investigated in the attrituximab and docetaxel experiments in OAK, respectively, Kaplan-Meier plots and comparative plots of OS and PFS of different metastatic organ populations based on the attrituximab and docetaxel groups were plotted, as shown in figure 2, wherein A is a Kaplan-Meier curve of OS of the attrituximab group, B is a Kaplan-Meier curve of OS of the docetaxel group, C is an OS comparison graph of the attrituximab group and the docetaxel group, D is a Kaplan-Meier curve of PFS of the attrituximab group, E is a Kaplan-Meier curve of PFS of the docetaxel group, F is a PFS comparison graph of the attrituximab group and the docetaxel group, the total survival in fig. 2A and 2B can be referred to as fig. 2C, and the total survival in fig. 2D and 2E can be referred to as fig. 2F.

As for OS, there was a significant difference in OS among patients treated with atuzumab in patients with different organ metastases (P ═ 0.0105; as in fig. 2A). However, the survival of the population receiving docetaxel treatment was independent of the metastatic organs, and there was no significant difference in OS (P-0.3742; see fig. 2B).

Pairwise comparisons of metastatic organs in the alemtuzumab group showed a more significant survival benefit for patients with adrenal metastases and brain metastases compared to metastases of liver, bone and pleural effusions, with a significant prolongation of OS (lower triangle in fig. 2C). However, for the docetaxel group, there was no significant difference in OS between any pair of metastatic organs (as in the upper triangle in fig. 2C).

Consistent results were observed in Progression Free Survival (PFS): there was a significant difference in survival among patients with different metastatic organs receiving alemtuzumab treatment (P ═ 0.0167; as in fig. 2D), but not in the docetaxel treated population (P ═ 0.8242; as in fig. 2E).

Consistent with this, there was a significant difference in PFS for only the attritumab group (lower triangle in fig. 2F) in two-by-two comparison, but not for the docetaxel group (upper triangle in fig. 2F).

(2) Predicted effect of immunotherapy on metastatic organ profiles is dependent on PD-L1 status

In view of the clinical practice of immunotherapy in patients positive for PD-L1 (> 1%), to investigate the predictive effect of metastatic organ profiles stratified at the expression level of PD-L1, forest plots of OS based on (A) overall (B) PD-L1 positive (TC/IC > 1%) and (C) PD-L1 negative (TC/IC < 1%) populations of the attrituximab group versus the docetaxel group were plotted, as shown in FIG. 3.

By comparing the efficacy of ICI treatment with that of chemotherapy, a clear correlation between clinical benefit of atezumab and metastatic organ profiles in the OAK cohort was found relative to docetaxel (see figure 3A).

Predicted effects were only observed in PD-L1 positive populations (PD-L1 positive: TC/IC ≧ 1%, as in FIG. 3B; PD-L1 negative: TC/IC < 1%, as in FIG. 3C) as shown by comparison of the effects of the stratification of PD-L1 expression levels.

It was found that the predictive significance of different metastatic organs was different, and even opposite, in the population positive for PD-L1. These metastatic organs are divided into two categories according to their predicted value for ICI treatment. Class I metastatic organs are defined as organs that have a significant survival benefit after receiving immunotherapy (compared to chemotherapy), while others are defined as class II metastatic organs.

For class I organs, astuzumab had significant OS benefit compared to docetaxel in patients with tumor metastasis to adrenal (HR 0.42, 95% CI 0.25-0.70), brain (HR 0.41, 95% CI 0.19-0.88) and liver (HR 0.57, 95% CI 0.36-0.89) (see fig. 3B). Whereas, for bone, pleural effusion and mediastinum class II, atelizumab had no benefit for survival of patients with metastases from these class II compared to docetaxel (see fig. 3B).

In view of the predicted effect of single class I organ metastases on immunotherapy, further to explore whether the predicted effects between different metastatic organ metastases could work synergistically, Kaplan-Meier plots of OS for the PD-L1 positive alemtuzumab versus docetaxel groups based on different numbers of metastatic organs were plotted, as shown in fig. 4, where

From figure 4, it was found that there is a synergistic predictive effect in class I organ metastases (adrenal, brain and liver) in the PD-L1 positive population.

The OS benefit of cetirizumab compared to docetaxel was more pronounced in patients transferred to both class I organs (HR 0.59, 95% CI 0.41-0.85P ═ 0.0048; fig. 4C) relative to patients transferred to a single class I organ (HR 0.32, 95% CI 0.14-0.76, P ═ 0.0013; fig. 4B).

To study the prediction and prognostic effect of class I metastatic organs, Kaplan-Meier plots of OS based on different metastatic organ numbers of the PD-L1 positive attrituzumab group and docetaxel group were plotted, as shown in fig. 5, where a is the Kaplan-Meier plot of OS based on different metastatic organ numbers of the PD-L1 positive attrituzumab group and B is the Kaplan-Meier plot of OS based on different metastatic organ numbers of the PD-L1 positive docetaxel group.

In the PD-L1 positive population, the appearance of class I organ metastases was associated with a decrease in OS in docetaxel group (P < 0.0001; fig. 5B), suggesting an inherent adverse prognostic effect of the metastases. Whereas the OS of the amilizumab group was not affected by the number of class I organ metastases (P-0.5978; fig. 5A), indicating that the positive predictive effect characteristic of immunotherapy for class I organ metastases counteracted its adverse prognostic effect.

(3) Predicting ICI treatment based on metastatic organ spectra

The metastatic organ profile is a determinant of intrinsic prognosis and immunotherapy prediction, and its synergy suggests that a comprehensive assessment should be made overall. Therefore, only by combining prognosis and prediction of the entire metastatic organ spectrum can its impact on ICI treatment be truly reflected.

Therefore, a Nomogram of a method for constructing a model for predicting the outcome of non-small cell lung cancer immune checkpoint inhibition therapy is plotted, as shown in fig. 6. Using the PD-L1 positive OAK cohort, a scoring system based on organ metastasis profiles (METscore) was constructed to predict survival outcome in advanced NSCLC patients treated with ICI drugs. Treatment of advanced NSCLC in the PD-L1-positive OAK cohort was particularly evident with ICI drugs (see fig. 6A).

On this basis, organ metastases were obtained for the patients by baseline imaging assessment. Multivariate Cox proportional hazards regression was performed to delineate the predicted and prognostic effects of each metastatic organ by incorporating the organ metastasis status, treatment groups, and interaction terms between individual organs and treatments, as shown in table 1 below. The range of model coefficients is normalized to the range of-5 to 5 and rounded to the nearest integer for clinical use. The normalized score corresponding to the organ metastasis status describes the prognostic effect of intrinsic therapy, while the normalized score of the organ metastasis and therapy interaction term describes the specific predictive effect of immunotherapy.

TABLE 1 prediction and prognostic Effect for each metastatic organ

The overall score of prognosis and predicted effect of the overall metastatic organ profile constitutes the METscore that predicts survival benefit after ICI treatment. The input variables of the model are seven binary variables, 0 represents no metastasis, 1 represents metastasis, and the variables are ADRENAL (ADRENAL gland), BRAIN (BRAIN), LIVER (LIVER), BONE (BONE), PEFF (pleural effusion), PLEURA (PLEURA) and MEDIA (mediastinum), respectively. The specific calculation is as follows:

the prognosis score is 3 × ADRENAL +2 × BRAIN +5 × LIVER +1 × BONE +1 × PEFF +0 × PLEURA +0 × MEDIA.

The prediction score (-5) × ADRENAL + (-5) × brake + (-3) × LIVER +1 × BONE +2 × PEFF +0 × plain +1 × MEDIA.

METscore ═ prognostic score + predictive score.

The predicted effect of METscore on immunotherapy using different cut-off values (0-5) was evaluated in the attrituzumab population (see figure 6B). The lower METscore patient group had a longer OS compared to the higher METscore patient group, and if a more stringent cut-off value was chosen (4 and 5), the difference in OS between the two groups was found to increase (see fig. 6B). In practical applications, the optimal cut-off value of the MET score is determined by balancing the survival benefit with the minimum proportion of each group, corresponding to 3 obtained by selecting the maximum rank statistic. METscore was binomized by an optimal cut-off value (. gtoreq.3vs. <3) and patients were classified into METscore-High (METscore. gtoreq.3) and-Low (METscore < 3).

In order to better serve the wide applicable population, and to enable the simple application of the model, a Web tool for METscore calculation (https:// METscore-ici. github. io/Pages /) is provided, as shown in FIG. 7, to distinguish the high and low risk populations of METscore.

Example 2

Verification and comparison of predictive models

(1) METscore is able to identify populations benefiting from immune checkpoint inhibition therapy

First, the METscore system was validated in the PD-L1 selected OAK cohort, two one-armed clinical cohorts (FIR and BIRCH), and the real world cohort (NFyy-ICI) cohort.

For this purpose, Kaplan-Meier plots of the OSs of different METscores in PD-L1 positive populations based on OAK, FIR, BIRCH, NFyy-ICI are plotted, as shown in FIG. 8, where A is the Kaplan-Meier curves of the OSs of different METscores of the atlas group of the OAK cohort, B is the Kaplan-Meier curves of the OSs of different METscores of the docetaxel group of the OAK cohort, C is the Kaplan-Meier curves of the OSs of different METscores of the atlas group of the FIR cohort, D is the Kaplan-Meier curves of the OSs of different METscores of the atlas group of the BIRCH cohort, and E is the Kaplan-Meier curves of the different METscores of the atlas group of the NFyy-ICI cohort.

The differential performance of METscore in the PD-L1 positive OAK cohort was first assessed.

In the attritumab-treated population, the OS was significantly longer in patients in the METscore-Low group than in patients in the METscore-High group (HR 0.48, 95% CI 0.32-0.72, P < 0.0001; see FIG. 8A). In contrast, there was no significant difference in OS between the METscore-Low and-High groups in docetaxel treated humans (HR 0.73, 95% CI 0.49-1.07, P ═ 0.0805; fig. 8B).

In the FIR cohort, there was a significant difference in OS between the two METscore-High and METscore-Low groups (HR 0.57, 95% CI 0.33-0.97, P0.0350; see FIG. 8C); in the BIRCH cohort, a significant prolongation of the METscore-Low group OS over the METscore-High group was also observed (HR 0.53, 95% CI 0.40-0.71, P < 0.0001; see FIG. 8D).

In addition, the generalization of METscore in the NFyy-ICI cohort was also confirmed, with the METscore-Low group having an extended OS compared to the METscore-High group (HR 0.60, 95% CI 0.39-0.92, P0.0181; FIG. 8E).

These results indicate that METscore is able to non-invasively identify the beneficiaries of ICI therapy, i.e., METscore-Low patients.

(2) Promotion of METscore in first line treatment cohort

Next, given that ICI has become the first line treatment for advanced non-small cell lung cancer, the differential performance of METscore in first line treatment was also evaluated.

Therefore, Kaplan-Meier curves of OS and PFS of different METscores after receiving first-line immunotherapy in a population screened by PD-L1 based on FIR, BIRCH and NFyy-ICI are drawn, as shown in FIG. 9, wherein A is the Kaplan-Meier curve of OS of different METscores receiving first-line immunotherapy in FIR and BIRCH cohorts, B is the Kaplan-Meier curve of PFS of different METscores receiving first-line immunotherapy in FIR and BIRCH cohorts, C is the Kaplan-Meier curve of OS of different METscores receiving first-line immunotherapy in NFyy-ICI cohorts, and D is the Kaplan-Meier curve of PFS of different METscores receiving first-line immunotherapy in NFyy-ICI cohorts.

In the first line FIR/BIRCH cohort, patients with METscore-Low had significantly longer survival compared to patients with METscore-High, whether OS (HR 0.44, 95% CI 0.23-0.83, P ═ 0.0087; as in fig. 9A) or PFS (HR 0.56, 95% CI 0.35-0.91, P ═ 0.0180; as in fig. 9B).

In the first-line NFyy-ICI cohort, both OS (HR 0.51, 95% CI0.29-0.90, P ═ 0.0182; as in fig. 9C) and PFS (HR0.45, 95% CI0.25-0.80, P ═ 0.0045; as in fig. 9D) also showed a significant improvement in survival outcome for the METscore-Low group over the METscore-High group.

In conclusion, METscore can show high clinical predictive value in both single arm FIR and BIRCH cohorts and the real world NFyy-ICI cohort.

While the invention has been described in terms of preferred embodiments, it will be apparent to those skilled in the art that the invention is susceptible to various modifications and alternative forms. Any modification, equivalent replacement, or improvement made within the spirit and principle of the present invention should be included in the protection scope of the present invention.