Abstract
Introduction
Currently, the prognosis of resected N2 non-small cell lung cancer patients undergoing neoadjuvant radiotherapy is poor. The goal of this research was to develop and validate a novel nomogram for exactly predicting the overall survival (OS) of resected N2 NSCLC patients undergoing neoadjuvant radiotherapy.
Methods
The data applied in our research were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. We divided selected data into a training cohort and a validation cohort using R software, with a ratio of 7:3. Univariate Cox regression and multivariate Cox regression were utilized to select significant variables to build the nomogram. To validate our nomogram, calibration curves, receiver operating characteristic curves (ROC), decision curve analysis (DCA), and Kaplan–Meier survival curves were employed. The nomogram model was also compared with the tumor–node–metastasis (TNM) staging system by utilizing net reclassification index (NRI) and integrated discrimination improvement (IDI).
Results
Eight variables—age, sex, operative type, LN removed number, chemotherapy, AJCC stage, M stage, histology—were statistically significant in the multivariate Cox regression analysis and were selected to develop our nomogram. Based on ROC curves, calibration curves, and DCA analysis, our novel nomogram demonstrated good predictive accuracy and clinical utility. Using Kaplan–Meier (KM) survival curves and log-rank tests, the risk stratification system was able to stratify patients based on their estimated mortality risk. The nomogram performed better than the TNM staging system based on the NRI and IDI indexes.
Conclusions
We developed and validated a nomogram to predict prognosis of resected N2 NSCLC patients undergoing neoadjuvant radiotherapy. Using this nomogram, clinicians may find this nomogram useful in predicting OS of targeted patients and making more appropriate treatment decisions.
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Availability of data and materials
SEER Stat 8.401 software was used to extract our data online, and data in our study are available at SEER database: https://seer.cancer.gov/
Abbreviations
- NSCLC:
-
Non-small cell lung cancer
- SEER:
-
Surveillance, epidemiology, and end results
- OS:
-
Overall survival
- AJCC:
-
American Joint Committee on Cancer
- ROC:
-
Receiver operating characteristic curves
- DCA:
-
Decision curve analysis
- TNM:
-
Tumor–node–metastasis
- NRI:
-
Net reclassification index
- IDI:
-
Integrated discrimination improvement
- KM:
-
Kaplan–Meier
- CSCO:
-
The Chinese Society of Clinical Oncology
- NCCN:
-
National Comprehensive Cancer Network
- UICC:
-
Union for International Cancer Control
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Acknowledgements
The authors would like to express their gratitude to SEER for providing free access to the database.
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LZ, JS and BP designed the study. JS wrote and edited the manuscript. CW, XZ, TL, RX, JS created the figures and tables. XC handled the partial data. KW, ZS, CX, JS collected the data. All authors contributed to the article and approved the submitted version.
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Since the patient information in the SEER database is deidentified and publicly available, our study was exempt from Institutional Review Board approval. In addition, we declared all methods were carried out in accordance with relevant guidelines and regulations.
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Shi, J., Peng, B., Wang, C. et al. Development and validation of a nomogram for predicting overall survival of resected N2 non-small cell lung cancer patients undergoing neoadjuvant radiotherapy. J Cancer Res Clin Oncol 149, 11779–11790 (2023). https://doi.org/10.1007/s00432-023-05073-7
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DOI: https://doi.org/10.1007/s00432-023-05073-7