Abstract
PurposeThis study aimed to construct two prognostic nomograms to predict survival in patients with non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) using a novel set of clinical parameters.Patients and MethodsTwo nomograms were developed, using a retrospective analysis of 5384 NSCLC and 647 SCLC patients seen during a 10-year period at Xiang Ya Affiliated Cancer Hospital (Changsha, China). The patients were randomly divided into training and validation cohorts. Univariate and multivariate analyses were used to identify the prognostic factors needed to establish nomograms for the training cohort. The model was internally validated via bootstrap resampling and externally certified using the validation cohort. Predictive accuracy and discriminatory capability were estimated using concordance index (C-index), calibration curves, and risk group stratification.ResultsThe largest contributor to overall survival (OS) prognosis in the NSCLC nomogram was the therapeutic regimen and diagnostic method parameters, and in the SCLC nomogram was the therapeutic regimen and health insurance plan parameters. Calibration curves for the nomogram prediction and the actual observation were in optimal agreement for the 3-year OS and acceptable agreement for the 5-year OS in both training datasets. The C-index was higher for the NSCLC cohort nomogram than for the TNM staging system (0.67 vs. 0.64, P = 0.01) and higher for the SCLC nomogram than for the clinical staging system (limited vs. extensive) (0.60 vs. 0.53, P = 0.12).ConclusionTreatment regimen parameter made the largest contribution to OS prognosis in both nomograms, and these nomograms might provide clinicians and patients a simple tool that improves their ability to accurately estimate survival based on individual patient parameters rather than using an averaged predefined treatment regimen.
Highlights
Cancer is the second most common cause of death globally and lung cancer is the leading cause of cancer deaths worldwide [1]
The concordance index (C-index) was higher for the non-small cell lung cancer (NSCLC) cohort nomogram than for the TNM staging system (0.67 vs. 0.64, P = 0.01) and higher for the small cell lung cancer (SCLC) nomogram than for the clinical staging system (0.60 vs. 0.53, P = 0.12)
Lung cancers can be divided into two categories, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), which account for 85% and 15% of cases, respectively [2]
Summary
Cancer is the second most common cause of death globally and lung cancer is the leading cause of cancer deaths worldwide [1]. Lung cancers can be divided into two categories, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), which account for 85% and 15% of cases, respectively [2]. For patients with early-stage NSCLC, radical resection is the most common and potentially curative treatment, whereas www.impactjournals.com/oncotarget patients with late-stage NSCLC receive a combination of adjuvant chemotherapy with complete resection [3]. Adjuvant radiotherapy and chemotherapy are typically recommended for high risk patients with lung cancer and more aggressive malignancies involving lymph nodes or residual cancer [4]. The prognosis for patients with lung cancer remains poor with an overall 5-year survival rate of approximately 15% [7]. The discriminatory value of prognostic biological markers is insufficient to predict an individual’s overall survival (OS) [8], and survival time has improved little in recent decades [9]
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