Abstract
Background: An increasing number of studies have shown that the positive lymph node ratio (pLNR) can be used to evaluate the prognosis of non-small cell lung cancer (NSCLC) patients. To determine the predictive value of the pLNR, we collected data from the Surveillance, Epidemiology, and End Results (SEER) database and performed a retrospective analysis.Methods: We collected survival and clinical information on patients with T1−4N1−3M0 NSCLC diagnosed between 2010 and 2016 from the SEER database and screened them according to inclusion and exclusion criteria. X-tile software was used to obtain the best cut-off value for the pLNR. Then, we randomly divided patients into a training set and a validation set at a ratio of 7:3. Pearson's correlation coefficient, tolerance and the variance inflation factor (VIF) were used to detect collinearity between variables. Univariate and multivariate Cox regression analyses were used to identify significant prognostic factors, and nomograms was constructed to visualize the results. The concordance index (C-index), calibration curves, and decision curve analysis (DCA) were used to assess the predictive ability of the nomogram. We divided the patient scores into four groups according to the interquartile interval and constructed a survival curve using Kaplan–Meier analysis.Results: A total of 6,245 patients were initially enrolled. The best cut-off value for the pLNR was determined to be 0.55. The nomogram contained 13 prognostic factors, including the pLNR. The pLNR was identified as an independent prognostic factor for both overall survival (OS) and cancer-specific survival (CSS). The C-index was 0.703 (95% CI, 0.695–0.711) in the training set and 0.711 (95% CI, 0.699–0.723) in the validation set. The calibration curves and DCA also indicated the good predictability of the nomogram. Risk stratification revealed a statistically significant difference among the four groups of patients divided according to quartiles of risk score.Conclusion: The nomogram containing the pLNR can accurately predict survival in patients with T1−4N1−3M0 NSCLC.
Highlights
As the global population ages, cancer is becoming an increasing burden on human health
The positive lymph node ratio (pLNR) was identified as an independent prognostic factor for both overall survival (OS) and cancer-specific survival (CSS)
The concordance index (C-index) was 0.703 in the training set and 0.711 in the validation set
Summary
As the global population ages, cancer is becoming an increasing burden on human health. Among all the pathological types of lung cancer, non-small cell lung cancer (NSCLC) is the most common type, accounting for 80% of all lung cancers [1, 2]. The death rate of lung cancer patients in the United States has decreased gradually, whereas that in China is still increasing. The incidence of lung cancer among non-smokers in China is significantly higher than that in the United States, especially among women [3]. An increasing number of studies have shown that the positive lymph node ratio (pLNR) can be used to evaluate the prognosis of non-small cell lung cancer (NSCLC) patients. To determine the predictive value of the pLNR, we collected data from the Surveillance, Epidemiology, and End Results (SEER) database and performed a retrospective analysis
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