Prediction Model for Lung Cancer in High-Risk Nodules Being Considered for Resection: Development and Validation in a Chinese Population

Abstract

BackgroundDetermining benign and malignant nodules before surgery is very difficult when managing patients with pulmonary nodules, which further makes it difficult to choose an appropriate treatment. This study aimed to develop a lung cancer risk prediction model for predicting the nature of the nodule in patients’ lungs and deciding whether to perform a surgical intervention.MethodsThis retrospective study included patients with pulmonary nodules who underwent lobectomy or sublobectomy at Tianjin Medical University General Hospital between 2017 and 2020. All subjects were further divided into training and validation sets. Multivariable logistic regression models with backward selection based on the Akaike information criterion were used to identify independent predictors and develop prediction models.ResultsTo build and validate the model, 503 and 260 malignant and benign nodules were used. Covariates predicting lung cancer in the current model included female sex, age, smoking history, nodule type (pure ground-glass and part-solid), nodule diameter, lobulation, margin (smooth, or spiculated), calcification, intranodular vascularity, pleural indentation, and carcinoembryonic antigen. The final model of this study showed excellent discrimination and calibration with a concordance index (C-index) of 0.914 (0.890–0.939). In an independent sample used for validation, the C-index for the current model was 0.876 (0.825–0.927) compared with 0.644 (0.559–0.728) and 0.681 (0.605–0.757) for the Mayo and Brock models. The decision curve analysis showed that the current model had higher discriminatory power for malignancy than the Mayo and the Brock models.ConclusionsThe current model can be used in estimating the probability of lung cancer in nodules requiring surgical intervention. It may reduce unnecessary procedures for benign nodules and prompt diagnosis and treatment of malignant nodules.

Nomogram combining clinical and radiological characteristics for predicting the malignant probability of solitary pulmonary nodules measuring ≤ 2 cm

“…Based on these results, a clinical prediction model for SPNs measuring ≤ 2 cm was developed by incorporating one general clinical indicator (age), four imaging indicators (shape, calcification, maximum tumor diameter, and CTR), and one laboratory indicator (CEA). Although various independent risk factors in this model have been previously reported (41)(42)(43)(44)(45)(46)(47)(48)(49)(50), not one has yet included CTR along with clinical and laboratory indicators to predict the malignancy of SPNs measuring ≤ 2 cm. Some patients have clinical features that are considered risk factors for lung malignancy, such as advancing age, sex, smoking history, and chronic obstructive pulmonary disease (24,41,42,(51)(52)(53)(54)(55).…”