Abstract
BackgroundIn the treatment of lung cancer, an accurate estimation of patient clinical outcome is essential for choosing an appropriate course of therapy. It is important to develop a prognostic stratification model which combines clinical, pathological and demographic factors for individualized clinical decision making.Methodology/Principal FindingsA total of 234,412 patients diagnosed with adenocarcinomas or squamous cell carcinomas of the lung or bronchus between 1988 and 2006 were retrieved from the SEER database to construct a prognostic model. A model was developed by estimating a Cox proportional hazards model on 500 bootstrapped samples. Two models, one using stage alone and another comprehensive model using additional covariates, were constructed. The comprehensive model consistently outperformed the model using stage alone in prognostic stratification and on Harrell's C, Nagelkerke's R2, and Brier Scores in the whole patient population as well as in specific treatment modalities. Specifically, the comprehensive model generated different prognostic groups with distinct post-operative survival (log-rank P<0.001) within surgical stage IA and IB patients in Kaplan-Meier analyses. Two additional patient cohorts (n = 1,991) were used as an external validation, with the comprehensive model again outperforming the model using stage alone with regards to prognostic stratification and the three evaluated metrics.Conclusion/SignificanceThese results demonstrate the feasibility of constructing a precise prognostic model combining multiple clinical, pathologic, and demographic factors. The comprehensive model significantly improves individualized prognosis upon AJCC tumor staging and is robust across a range of treatment modalities, the spectrum of patient risk, and in novel patient cohorts.
Highlights
Lung cancer is one of the most aggressive cancer types and consistently the leading cause of cancer-related death in the United States for both men and women
This study focused on two major cell types of Non-small cell lung cancer (NSCLC), lung adenocarcinoma and squamous cell carcinoma
The low-risk group defined by the comprehensive model was compared with AJCC stage I; the intermediate-risk group was compared with AJCC stage II and IIIA; whereas the high-risk group was compared with AJCC stage IIIB/IV
Summary
Lung cancer is one of the most aggressive cancer types and consistently the leading cause of cancer-related death in the United States for both men and women. Tumor stage is strongly predictive of survival in most cases, it does not explain the distinct variability in treatment outcome within patients of the same stage. Surgery is the major treatment option for patients with stage I NSCLC. 35–50% of stage I NSCLC patients will relapse within five years [2,3], which is the major cause of treatment failure, i.e. death from lung cancer. It remains an unsolved challenge for physicians to reliably identify patients at high risk for tumor recurrence as candidates for adjuvant chemotherapy. It is important to develop a prognostic stratification model which combines clinical, pathological and demographic factors for individualized clinical decision making
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
