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Prognostic value of nutritional and inflammatory biomarkers in patients with non‑small cell lung cancer and bone metastasis: A retrospective study

  • Authors:
    • Yuanjiao Chen
    • Lu Zhang
    • Shuting Wang
    • Huangren Zou
    • Yanlin Liu
    • Yuke Bai
    • Zhiyong Deng
    • Chao Liu
    • Suyun Yang
  • View Affiliations / Copyright

    Affiliations: Nursing College of Shanxi Medical University, Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030012, P.R. China, Department of Nuclear Medicine, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650118, P.R. China, Department of Thoracic Surgery Ⅱ, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650118, P.R. China
    Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 418
    |
    Published online on: July 21, 2026
       https://doi.org/10.3892/ol.2026.15773
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Abstract

To evaluate the prognostic significance of nutritional‑inflammatory biomarkers in non‑small cell lung cancer (NSCLC) patients with bone metastases. The present study constructed prognostic models using machine learning methods and assessed their performance, aiming to develop a clinically practical nomogram. A retrospective analysis of 233 patients with NSCLC and confirmed bone metastasis (BM) was conducted. The present study analyzed clinical and laboratory data, including 10 nutritional‑inflammatory indicators. The present study used univariate and multivariate Cox regression, Least Absolute Shrinkage and Selection Operator (LASSO), Random Forest and extreme gradient boosting to select variables and construct Cox models. Performance was assessed via C‑index, time‑dependent area under the curve, Brier score, calibration curve and Akaike information criterion (AIC). A nomogram was developed based on the best‑performing model. Multivariate Cox regression identified history of primary tumor surgery [hazard ratio (HR)=0.35; P<0.001], hemoglobin (HR=0.99; P=0.02), prognostic nutritional index (HR=0.98; P=0.002), CYFRA21‑1 (HR=1.01; P<0.001), neuron‑specific enolase (NSE; HR=1.03; P<0.001) and total cholesterol (HR=1.05; P=0.006) as independent prognostic factors. Individual nutritional‑inflammatory biomarkers demonstrated limited discrimination (C‑index range: 0.48‑0.58). By contrast, integrated models incorporating these markers markedly improved predictive performance. The LASSO_yes model achieved the highest C‑index (0.74; 95% CI: 0.70‑0.77), with a 24‑month area under the curve of 0.79 and the lowest Akaike information criterion (AIC; 1684.6). Based on the best‑performing model, a prognostic nomogram was constructed to estimate individualized survival probabilities. Nutritional‑inflammatory biomarkers provide incremental prognostic value when incorporated into integrated models. The LASSO‑based nomogram may provide a potentially practical tool for individualized survival prediction in patients with NSCLC with BM, although external validation is still required before broader clinical application.
View Figures

Figure 1

Study flow diagram. Overview of
patient selection, data collection, statistical analysis and model
development procedures. NSCLC, non-small cell lung cancer; LASSO,
Least Absolute Shrinkage and Selection Operator.

Figure 2

Forest plot of multivariable Cox
regression analysis for overall survival in patients with NSCLC
with bone metastasis. *P<0.05; **P<0.01; ***P<0.001.
NSCLC, non-small cell lung cancer; AIC, Akaike information
criterion.

Figure 3

Kaplan-Meier survival curves for
overall survival according to independent prognostic factors,
including NSE, CYFRA21-1, TC, PNI, Hb, and primary focal surgical
history in patients with NSCLC with bone metastasis. NSE,
neuron-specific enolase; TC, total cholesterol; PNI, prognostic
nutritional index; Hb, hemoglobin; NSCLC, non-small cell lung
cancer.

Figure 4

Pairwise comparison of C-index values
among prognostic models with and without nutritional-inflammatory
markers for predicting overall survival in patients with NSCLC with
bone metastasis. Statistical significance was assessed using paired
t-tests. C-index, concordance index; NSCLC, non-small cell lung
cancer; RF, Random Forest; XGBoost, extreme gradient boosting.

Figure 5

Time-dependent ROC curves of
prognostic models with and without nutritional-inflammatory markers
for predicting overall survival at 6, 12, and 24 months in patients
with NSCLC with bone metastasis. ROC, receiver operating
characteristic; NSCLC, non-small cell lung cancer; LASSO, Least
Absolute Shrinkage and Selection Operator; RF, Random Forest;
XGBoost, extreme gradient boosting.

Figure 6

Comparison of calibration curves for
predicting overall survival at 1, 3, and 5 years between models
with and without nutritional-inflammatory markers in patients with
NSCLC and bone metastasis. NSCLC, non-small cell lung cancer;
LASSO, Least Absolute Shrinkage and Selection Operator; RF, Random
Forest; XGBoost, extreme gradient boosting.

Figure 7

Kaplan-Meier survival curves for high-
and low-risk groups stratified by six prognostic models, with
statistical significance assessed using the log-rank test. LASSO,
Least Absolute Shrinkage and Selection Operator; RF, Random Forest;
XGBoost, extreme gradient boosting.

Figure 8

LASSO-based prognostic nomogram for
predicting 1-, 3-, and 5-year death probability in patients with
NSCLC with bone metastasis. The nomogram was developed based on the
LASSO-selected multivariable Cox regression model. LASSO, Least
Absolute Shrinkage and Selection Operator; NSCLC, non-small cell
lung cancer; CAR, C-reactive protein-to-albumin ratio; NSE,
neuron-specific enolase; WBC, white blood cell count; LDH, lactate
dehydrogenase; ESR, erythrocyte sedimentation rate; SII, systemic
immune-inflammation index; Hb, hemoglobin; PNI, prognostic
nutritional index.
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Copy and paste a formatted citation
Spandidos Publications style
Chen Y, Zhang L, Wang S, Zou H, Liu Y, Bai Y, Deng Z, Liu C and Yang S: Prognostic value of nutritional and inflammatory biomarkers in patients with non‑small cell lung cancer and bone metastasis: A retrospective study. Oncol Lett 32: 418, 2026.
APA
Chen, Y., Zhang, L., Wang, S., Zou, H., Liu, Y., Bai, Y. ... Yang, S. (2026). Prognostic value of nutritional and inflammatory biomarkers in patients with non‑small cell lung cancer and bone metastasis: A retrospective study. Oncology Letters, 32, 418. https://doi.org/10.3892/ol.2026.15773
MLA
Chen, Y., Zhang, L., Wang, S., Zou, H., Liu, Y., Bai, Y., Deng, Z., Liu, C., Yang, S."Prognostic value of nutritional and inflammatory biomarkers in patients with non‑small cell lung cancer and bone metastasis: A retrospective study". Oncology Letters 32.3 (2026): 418.
Chicago
Chen, Y., Zhang, L., Wang, S., Zou, H., Liu, Y., Bai, Y., Deng, Z., Liu, C., Yang, S."Prognostic value of nutritional and inflammatory biomarkers in patients with non‑small cell lung cancer and bone metastasis: A retrospective study". Oncology Letters 32, no. 3 (2026): 418. https://doi.org/10.3892/ol.2026.15773
Copy and paste a formatted citation
x
Spandidos Publications style
Chen Y, Zhang L, Wang S, Zou H, Liu Y, Bai Y, Deng Z, Liu C and Yang S: Prognostic value of nutritional and inflammatory biomarkers in patients with non‑small cell lung cancer and bone metastasis: A retrospective study. Oncol Lett 32: 418, 2026.
APA
Chen, Y., Zhang, L., Wang, S., Zou, H., Liu, Y., Bai, Y. ... Yang, S. (2026). Prognostic value of nutritional and inflammatory biomarkers in patients with non‑small cell lung cancer and bone metastasis: A retrospective study. Oncology Letters, 32, 418. https://doi.org/10.3892/ol.2026.15773
MLA
Chen, Y., Zhang, L., Wang, S., Zou, H., Liu, Y., Bai, Y., Deng, Z., Liu, C., Yang, S."Prognostic value of nutritional and inflammatory biomarkers in patients with non‑small cell lung cancer and bone metastasis: A retrospective study". Oncology Letters 32.3 (2026): 418.
Chicago
Chen, Y., Zhang, L., Wang, S., Zou, H., Liu, Y., Bai, Y., Deng, Z., Liu, C., Yang, S."Prognostic value of nutritional and inflammatory biomarkers in patients with non‑small cell lung cancer and bone metastasis: A retrospective study". Oncology Letters 32, no. 3 (2026): 418. https://doi.org/10.3892/ol.2026.15773
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