A Nomogram to Predict Long-Term Survival Outcomes of Patients Who Undergo Pneumonectomy for Non-small Cell Lung Cancer With Stage I-IIIB

Abstract

Background: In this study, we aim to establish a nomogram to predict the prognosis of non-small cell lung cancer (NSCLC) patients with stage I-IIIB disease after pneumonectomy.Methods: Patients selected from the Surveillance, Epidemiology, and End Results (SEER, N = 2,373) database were divided into two cohorts, namely a training cohort (SEER-T, N = 1,196) and an internal validation cohort (SEER-V, N = 1,177). Two cohorts were dichotomized into low- and high-risk subgroups by the optimal risk prognostic score (PS). The model was validated by indices of concordance (C-index) and calibration plots. Kaplan-Meier analysis and the log-rank tests were used to compare survival curves between the groups. The primary observational endpoint was cancer-specific survival (CSS).Results: The nomogram comprised six factors as independent prognostic indictors; it significantly distinguished between low- and high-risk groups (all P < 0.05). The unadjusted 5-year CSS rates of high-risk and low-risk groups were 33 and 60% (SEER-T), 34 and 55% (SEER-V), respectively; the C-index of this nomogram in predicting CSS was higher than that in the 8th TNM staging system (SEER-T, 0.629 vs. 0.584, P < 0.001; SEER-V, 0.609 vs. 0.576, P < 0.001). In addition, the PS might be a significant negative indictor on CSS of patients with white patients [unadjusted hazard ration (HR) 1.008, P < 0.001], black patients (unadjusted HR 1.007, P < 0.001), and Asian or Pacific Islander (unadjusted HR 1.008, P = 0.008). In cases with squamous cell carcinoma (unadjusted HR 1.008, P < 0.001) or adenocarcinoma (unadjusted HR 1.008, P < 0.001), PS also might be a significant risk factor.Conclusions: For post-pneumonectomy NSCLC patients, the nomogram may predict their survival with acceptable accuracy and further distinguish high-risk patients from low-risk patients.

The Effect of Examined Lymph Nodes and Lymph Node Ratio on Pathological Nodal Classification in the Lung Adenosquamous Carcinoma After Lobectomy

“…LNR may reflect the patient’s tumor burden to some extent. Previous reports confirmed that LNR could be a predictive tool to evaluate the prognosis of non-small cell lung cancer patients ( 11 , 13 , 14 , 23 – 25 ). High-level LNR might be associated with the poor survival of those patients.…”

“…The examined lymph nodes (LNs) and lymph node ratio (LNR) were confirmed as the significant prognostic indicators for resected non-small cell lung cancers based on previous studies ( 11 – 14 ). LNR was defined as the ratio of the number of metastatic lymph nodes divided by the total number of dissected lymph nodes.…”

Occult Non-Small Cell Lung Cancer: An Underappreciated Disease

“…Finally, a nomogram was established. As is known that nomogram is a widely used and efficient tool for predicting prognosis in malignancies such as breast cancer [ 18 ], gastric cancer [ 19 ], esophageal carcinoma [ 20 ], and lung cancer [ 21 , 22 , 23 ]. The C-index of our nomogram was little pale (only 0.65).…”

The Construction and Validation of Nomogram to Predict the Prognosis with Small-Cell Lung Cancer Followed Surgery

“…In addition, the evaluation of the prognoses for those patients remains important. Previous studies confirmed that nomograms had better performance in predicting prognosis than classic tumor, nodes, and metastasis (TNM) staging systems [ 12 , 13 ]. Therefore, this study aimed to construct a nomogram to improve the predictive ability for survival outcomes, and give clinical reference of adjuvant radiotherapy in postoperative SCLC patients with limited stage.…”