Abstract
Objective: To assess the postoperative prognosis of patients with stage IB non-small cell lung cancer (NSCLC), using a prognostic model (PM).Methods: Patients with stage IB of NSCLC from the two academic databases {the Surveillance, Epidemiology, and End Results [SEER-A, N = 1,746 (training cohort)], Sun Yat-sen University Cancer Center [SYSUCC, N = 247 (validation cohort)], and SEER-B (N = 1,745)} who had undergone lung surgery from 2001 to 2015 were enrolled. The primary clinical endpoint was cancer-specific survival (CSS). Covariate inclusion of prognostic indicators was carried out using a multivariable two-sided P < 0.05. We identified and integrated significant prognostic factors for survival in the training cohort to build a model that could be validated in the validation cohort. We used univariate analysis to evaluate the utilized ability of PM in the different races/ethnicities.Results: CSS discrimination in the PM was comparable in both the training and validation cohorts [C index = 0.66(SEER-A), 0.67(SYSUCC), and 0.61(SEER-B), respectively]. Discretization with a fixed PM cutoff of 291.5 determined from the training dataset yielded low- and high-risk subgroups with disparate CSS in the validation cohort (training cohort: hazard ratio [HR] 2.724, 95% confidence intervals [CI], 2.074–3.577; validation cohort: SEER-B HR 1.679, 95% CI, 1.310–2.151, SYSUCC HR 3.649, 95% CI 2.203–6.043, all P < 0.05). Our five-factor PM was able to predict CSS; 48-month CSS was 87% in the low-risk subgroup vs. 69% in the high-risk subgroup for the training cohort, while in the validation cohort, they were 80 vs. 73%(SEER-B) and 84 vs. 60% (SYSUCC), respectively. In addition, the results showed that PM with all unadjusted HR > 1 was a significant risk prognostic indictor in white men (P < 0.001), Chinese people (P < 0.001), and other races (P = 0.012).Conclusion: We established and validated a PM that may predict CSS for patients with IB NSCLC in different races/ethnicities, and thus, help clinicians screen subgroups with poor prognosis. In addition, further prospective studies and more cases from different regions are necessary to confirm our findings.
Highlights
Lung cancer remains the most common cause of cancer-related morbidity and mortality [1]
The National Comprehensive Cancer Network guidelines recommend postoperative chemotherapy in patients with high-risk factors, such as vascular invasion, visceral pleural invasion, unknown lymph nodes status, and tumor diameter >4 cm [7]; the European Society for Medical Oncology guidelines recommend that adjuvant therapy be given to patients with a tumor diameter >4 cm [8] and the American Society of Clinical Oncology guidelines do not recommend routine treatment for stage IB patients [9]
We found that there was no significant difference between stage IA and low risk stage IB in cancer-specific survival (P = 0.029, Figure 4B)
Summary
Lung cancer remains the most common cause of cancer-related morbidity and mortality [1]. According to the 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual that was implemented in January 2017, the stratification effect on the overall survival (OS) rate is better than that in the 7th edition [4]. The National Comprehensive Cancer Network guidelines recommend postoperative chemotherapy in patients with high-risk factors, such as vascular invasion, visceral pleural invasion, unknown lymph nodes status, and tumor diameter >4 cm [7]; the European Society for Medical Oncology guidelines recommend that adjuvant therapy be given to patients with a tumor diameter >4 cm [8] and the American Society of Clinical Oncology guidelines do not recommend routine treatment for stage IB patients [9]. According to the 8th AJCC Staging Manual, stage IB is defined by the following: [1] tumor size >3-4 cm, with or without visceral pleural invasion (PL1/PL2); [2] tumor size 0–3 cm, with visceral pleural invasion (PL1/PL2); [3] tumor size 0–3 cm, infringing the main bronchus but with a distance ≥2 cm from the carina or with local pneumonia or with local atelectasis [4]
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