Survival Nomogram for Stage IB Non-Small-Cell Lung Cancer Patients, Based on the SEER Database and an External Validation Cohort.

Abstract

This study aimed to construct a nomogram to effectively predict the overall survival (OS) of patients with stage IB non-small-cell lung cancer (NSCLC). In total, 5513 patients with stage IB NSCLC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and used as the training cohort. We enrolled 440 patients from the Cancer Hospital, Chinese Academy of Medical Sciences, for the external validation cohort. A nomogram was constructed based on the risk factors affecting prognosis using a Cox proportional hazards regression model. The discrimination and calibration of the nomogram were evaluated by C-indexes and calibration curves. Six independent risk factors for OS were identified and integrated into the nomogram. The discrimination of the nomogram revealed good prognostic accuracy and clinical applicability as indicated by C-index values of 0.637 (95% CI 0.634-0.641) and 0.667 (95% CI 0.656-0.678) for the training cohort and the external validation cohort, respectively. Additionally, the patients were divided into two groups according to risk (sum-score>185), and significant differences in OS were observed between the high-risk and low-risk groups in the training and external validation cohorts (P<0.001). Finally, chemotherapy was significantly associated with OS in patients with differentiation grades II-IV (P=0.004) and patients with adenocarcinoma (P=0.005). This nomogram provides a convenient and reliable tool for individual evaluations and clinical decision-making for patients with stage IB NSCLC; among these patients, those with differentiation grades II-IV or adenocarcinoma could benefit from chemotherapy.