Abstract
BackgroundPreviously reported prognostic tools for patients with resected non-small cell lung cancer (NSCLC) include factors found postoperatively, but not preoperatively. However, it would be important to predict patient prognosis before NSCLC resection. To suggest a novel preoperative prognostic tool, we evaluated the relationship of preoperative prognostic factors with the survival of patients with resected NSCLC.MethodsWe retrospectively reviewed the data of two independent cohorts of patients with completely resected NSCLC. To develop the prognostic index in one cohort, the overall survival (OS) was evaluated using the Cox proportional hazards model. We assessed the disease-free survival (DFS) and OS of three risk groups defined according to the prognostic index. Then, the prognostic index was validated in the other cohort.ResultsSeven independent risk factors for OS were selected: age ≥ 70 years, ever-smokers, vital capacity <80%, neutrophil-to-lymphocyte ratio ≥ 2.1, cytokeratin 19 fragment >normal limit, non-usual interstitial pneumonia (UIP) pattern, and UIP pattern. Three risk groups were defined: low-risk (36.9%), intermediate-risk (54.0%), and high-risk (9.1%). In the derivation cohort, the 5-year DFS rate was 77.8%, 58.8%, and 22.6% (P < 0.001), and the 5-year OS rate was 95.2%, 70.4%, and 28.9% (P < 0.001), respectively. Multivariate analyses showed that the prognostic index predicted DFS and OS, independent of pathological stage and tumor histology, in both derivation and validation cohorts.ConclusionsWe developed and validated a simple preoperative prognostic index composed of seven variables, which may help clinicians predict prognosis before surgery in patients with NSCLC.
Highlights
Reported prognostic tools for patients with resected non-small cell lung cancer (NSCLC) include factors found postoperatively, but not preoperatively
The cases were categorized into two groups according to their radiologic appearance on high-resolution computed tomography (HRCT): (1) usual interstitial pneumonia (UIP) pattern: characterized by the presence of basal-dominant reticular opacities and predominantly basal and subpleural distribution of honeycomb lesions, with multiple equal-sized cystic lesions of 2 to 10 mm diameter with a thick wall; and (2) non-UIP pattern: characterized by the presence of basal-predominant ground glass opacities and infiltrative shadows inconsistent with UIP patterns
Development of the preoperative prognostic index To develop the prognostic index, we examined two prognostic indexes composed of the seven independent factors identified in the multivariate analysis: age ≥ 70 years, ever-smokers, %percent vital capacity (VC)
Summary
Reported prognostic tools for patients with resected non-small cell lung cancer (NSCLC) include factors found postoperatively, but not preoperatively. It would be important to predict patient prognosis before NSCLC resection. Pathological stage has been considered a strong prognostic factor for non-small cell lung cancer (NSCLC) [2]. Several preoperative factors including blood test markers and high-resolution computed tomography (HRCT) findings have been reported to predict the prognosis of patients with NSCLC. Neutrophilto-lymphocyte ratio (NLR), carcinoembryonic antigen (CEA) levels, and cytokeratin 19 fragment (CYFRA 21-1) levels have been demonstrated to predict the prognosis of patients with NSCLC [3,4,5,6,7,8,9,10,11,12]. Previous reports have shown that interstitial lung disease (ILD) is associated with a poor prognosis of NSCLC [13,14,15]
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