Abstract
Background: Lymph node metastasis (LNM) status is of key importance for the decision-making on treatment and survival prediction. There is no reliable method to precisely evaluate the risk of LNM in NSCLC patients. This study aims to develop and validate a dynamic nomogram to evaluate the risk of LNM in small-size NSCLC.Methods: The NSCLC ≤ 2 cm patients who underwent initial pulmonary surgery were retrospectively reviewed and randomly divided into a training cohort and a validation cohort as a ratio of 7:3. The training cohort was used for the least absolute shrinkage and selection operator (LASSO) regression to select optimal variables. Based on variables selected, the logistic regression models were developed, and were compared by areas under the receiver operating characteristic curve (AUCs) and decision curve analysis (DCA). The optimal model was used to plot a dynamic nomogram for calculating the risk of LNM and was internally and externally well-validated by calibration curves.Results: LNM was observed in 12.0% (83/774) of the training cohort and 10.1% (33/328) of the validation cohort (P = 0.743). The optimal model was used to plot a nomogram with six variables incorporated, including tumor size, carcinoembryonic antigen, imaging density, pathological type (adenocarcinoma or non-adenocarcinoma), lymphovascular invasion, and pleural invasion. The nomogram model showed excellent discrimination (AUC = 0.895 vs. 0.931) and great calibration in both the training and validation cohorts. At the threshold probability of 0–0.8, our nomogram adds more net benefits than the treat-none and treat-all lines in the decision curve.Conclusions: This study firstly developed a cost-efficient dynamic nomogram to precisely and expediently evaluate the risk of LNM in small-size NSCLC and would be helpful for clinicians in decision-making.
Highlights
Lung cancer is the most common cause of cancer-related death worldwide in recent years [1]
Lobectomy was performed for 870 patients and sublobar resection for 232 patients
For patients whose tumors were staged as T1N0M0, the standard therapy has been considered as lobectomy with systematic lymph node dissection (LND) [3]
Summary
Lung cancer is the most common cause of cancer-related death worldwide in recent years [1]. The sublobar resection (wedge resection and segmentectomy) has been used for early-stage NSCLC, especially for patients with impaired pulmonary function reserve [4] Compared with those who underwent systematic LND, patients that received selective LND presented a lower incidence of perioperative complications and similar survival [5, 6]. These sublevel surgical procedures would be more likely to cause tumor residual, since occult LNM occurred not rarely, even though in small-size NSCLC [7,8,9,10,11].
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