{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T06:31:33Z","timestamp":1786429893745,"version":"build-2736575974"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Older patients (aged \u2265 75 years) with advanced non-small cell lung cancer (NSCLC) receiving immunotherapy represent a growing but understudied population, yet few tools incorporate multidimensional host factors that influence prognosis. We therefore developed and externally validated a real-world prognostic model using bedside-available clinical variables, and compared its performance against conventional indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective study included patients aged \u2265 75 years with advanced NSCLC receiving first-line immunotherapy. Cox regression analyses were performed to identify potential survival-associated host variables. A composite model, based on clinically relevant candidate variables identified through univariate screening, was developed using endpoint-specific L2-penalized Cox regression and internally validated with 1,000 bootstrap resamples. The final model was externally validated in two independent cohorts. Model performance was assessed using Harrell\u2019s C-index, inverse probability of censoring-weighted (IPCW) cumulative\/dynamic area under the curve (AUC), calibration, decision curve analysis, and Kaplan-Meier survival analysis with log-rank tests. The model was formally compared with conventional indices using paired bootstrap analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 241 patients were included, with 115 in the development cohort and 126 in the pooled external validation cohort. We developed the CALI (Comorbidity-Advanced Lung Cancer Inflammation Index) model integrating comorbidity burden (hypertension, diabetes, chronic obstructive pulmonary disease), recent weight loss, and inflammatory-nutritional status represented by ALI. In the development cohort, 1- and 2-year AUCs were 0.587 and 0.712 for overall survival (OS), 0.584 and 0.708 for progression-free survival (PFS), with significant stratification for OS (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.013) and PFS (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.021). In the pooled validation cohort, 1- and 2-year AUCs were 0.561 and 0.806 for OS, 0.553 and 0.793 for PFS, also significant stratification for OS (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.006) and PFS (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.008). In paired comparisons, CALI showed modest but significant OS improvements over conventional indices, whereas PFS gains were less consistent.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      CALI provided modest prognostic discrimination and risk stratification in older patients with advanced NSCLC receiving immunotherapy, with stronger and more consistent performance for OS than for PFS. The model offers a simple, bedside-applicable tool using routinely available clinical variables, and can be easily accessed via our online calculator (\n                      <jats:ext-link>https:\/\/jccclv.github.io\/CALI-calculator<\/jats:ext-link>\n                      ) for individualized risk stratification.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1917659","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T06:20:37Z","timestamp":1786429237000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A comprehensive prognostic model for older patients with advanced non-small cell lung cancer receiving immunotherapy: a multicenter real-world study"],"prefix":"10.3389","volume":"17","author":[{"given":"Xinyu","family":"Song","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juncai","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongying","family":"Zheng","sequence":"additional","affiliation":[{"name":"Clinical Lab, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, 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