Development and validation of prognostic nomogram for T1-3N0M0 non-small cell lung cancer after curative resection

Abstract

Background Radical resection plus lymph node dissection is a common treatment for patients with T1-3N0M0 non-small cell lung cancer (NSCLC). Few models predicted the survival outcomes of these patients. This study aimed to developed a nomogram for predicting their overall survival (OS). Materials and methods This study involved 3002 patients with T1-3N0M0 NSCLC after curative resection between January 1999 and October 2013. 1525 Patients from Sun Yat-sen University Cancer Center were randomly allocated to training cohort and internal validation cohort in a ratio of 7:3. 1477 patients from ten institutions were recruited as external validation cohort. A nomogram was constructed based on the training cohort and validated by internal and external validation cohort to predict the OS of these patients. The accuracy and practicability were tested by Harrell's C-indexes, calibration plots and decision curve analyses (DCA). Results Age, sex, histological classification, pathological T stage, and HI standard were independent factors for OS and were included in our nomogram. The C-index of the nomogram for OS estimates were 0.671 (95% CI, 0.637–0.705),0.632 (95% CI, 0.581–0.683), and 0.645 (95% CI, 0.617–0.673) in the training cohorts, internal validation cohorts, and external validation cohort, respectively. The calibration plots and DCA for predictions of OS were in excellent agreement. An online version of the nomogram was built for convenient clinical practice. Conclusions Our nomogram can predict the OS of patients with T1-3N0M0 NSCLC after curative resection. The online version of our nomogram offer opportunities for fast personalized risk stratification and prognosis prediction in clinical practice.

Lymph Node Ratio Enhances Predictive Value for Treatment Outcomes in Patients with Non-Small Cell Lung Cancer Undergoing Surgery: A Retrospective Cohort Study

“…Previous studies have highlighted the prognostic importance of examining lymph nodes in NSCLC patients, 9 , 10 , 21 , 22 recognizing adequate lymphadenectomy as an independent prognostic factor correlated with better outcomes. However, discrepancies in surgical quality among hospitals and surgeons may affect the extent of lymph node examination, potentially limiting its ability to accurately represent the true N stages.…”

“…Studies have demonstrated a connection between the number of examined lymph nodes and patient survival, with a higher count associated with improved prognosis. 9 , 10 It has been suggested that 10 examined lymph nodes represent an adequate cut-off value for dissection, beyond which there is no further improvement in prognosis. 10 However, others propose 16 examined lymph nodes as the threshold for assessing the quality of lymph node examination and postoperative prognostic stratification in NSCLC patients who undergo surgery.…”

Role of Postoperative Radiotherapy on High-Risk Stage pIIIA-N2 Non-Small Cell Lung Cancer Patients After Complete Resection and Adjuvant Chemotherapy: A Retrospective Cohort Study

“…Among these factors, the prognostic significance of examined lymph nodes is an active area of research. Several studies suggest a correlation between the number of examined lymph nodes and patient survival, with higher counts linked to better outcomes [ 29 , 30 ]. However, the prognostic value of lymph node examination can be influenced by the quality of the surgical procedure [ 31 ].…”