Abstract
BackgroundSurvival outcomes of patients with resected SCLC differ widely. The aim of our study was to build a model for individualized risk assessment and accurate prediction of overall survival (OS) in resectable SCLC patients.MethodsWe collected 1052 patients with resected SCLC from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors were selected by COX regression analyses, based on which a nomogram was constructed by R code. External validation were performed in 114 patients from Shandong Provincial Hospital. We conducted comparison between the new model and the AJCC staging system. Kaplan–Meier survival analyses were applied to test the application of the risk stratification system.ResultsSex, age, T stage, N stage, LNR, surgery and chemotherapy were identified to be independent predictors of OS, according which a nomogram was built. Concordance index (C-index) of the training cohort were 0.721, 0.708, 0.726 for 1-, 3- and 5-year OS, respectively. And that in the validation cohort were 0.819, 0.656, 0.708, respectively. Calibration curves also showed great prediction accuracy. In comparison with 8th AJCC staging system, improved net benefits in decision curve analyses (DCA) and evaluated integrated discrimination improvement (IDI) were obtained. The risk stratification system can significantly distinguish the ones with different survival risk. We implemented the nomogram in a user-friendly webserver.ConclusionsWe built a novel nomogram and risk stratification system integrating clinicopathological characteristics and surgical procedure for resectable SCLC. The model showed superior prediction ability for resectable SCLC.
Highlights
Survival outcomes of patients with resected Small-cell lung cancer (SCLC) differ widely
Clinicopathological characteristics of the study cohorts Eventually, after the stepwise selection, a total of 1052 cases from SEER database were included into the training cohort, and 114 cases from Shandong Provincial Hospital were involved into the external validation cohort
By COX regression analyses, we identified age, sex, T stage, N stage, lymph nodes metastatic ratio (LNR), surgery and chemotherapy as independent predictors of overall survival
Summary
Survival outcomes of patients with resected SCLC differ widely. The aim of our study was to build a model for individualized risk assessment and accurate prediction of overall survival (OS) in resectable SCLC patients. Lung cancer remains an important public health concern affecting both men and women and the leading cause of cancer-associated mortality [1]. In the United states, there were estimated 234,030 new diagnosed lung cancer cases in 2018 [1]. Small-cell lung cancer (SCLC) is one of the aggressive pathology type and accounts for approximately 14–16% of all lung cancer cases [2, 3]. SCLC is the mainly neuroendocrine tumor of lung which has poor prognosis for its high vascularity, rapid doubling time and early metastasis. Treating choices of SCLC include surgery, chemotherapy and radiotherapy [4]. Systemic platinum-based chemotherapy either alone or combined with concurrent
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