ABSTRACT
Purpose
Survival nomograms offer individualized predictions using a more diverse set of factors than traditional staging measures, including the American Joint Committee on Cancer Tumor Node Metastasis (AJCC TNM) Staging System. A nomogram predicting overall survival (OS) for resected, non-metastatic non-small cell lung cancer (NSCLC) has been previously derived from Asian patients. The present study aims to determine the nomogram’s predictive capability in the US using the National Cancer Database (NCDB).
Methods
This was a retrospective review of adults with resected, non-metastatic NSCLC entered into the NCDB between 2004 and 2012. Concordance indices and calibration plots analyzed discrimination and calibration, respectively. Multivariate analysis was also used.
Results
A total of 57,313 patients were included in this study. The predominant histologies were adenocarcinoma (48.2%) and squamous cell carcinoma (31.3%), and patients were diagnosed with stage I-A (38.3%), stage I-B (22.7%), stage II-A (14.2%), stage II-B (11.5%), and stage III-A (13.3%). Median OS was 74 months. 1-, 3- and 5-year OS rates were 89.8% [95% confidence interval (CI) 89.5–90.0%], 71.1% (95% CI 70.7–71.6%), and 55.7% (95% CI 54.7–56.6%), respectively. The nomogram’s concordance index (C-index) was 0.804 (95% CI 0.792–0.817). AJCC TNM staging demonstrated higher discrimination (C-index 0.833, 95% CI 0.821–0.840).
Conclusions
The nomogram’s individualized estimates accurately predicted survival in this patient collective, demonstrating higher discrimination in this population than in the developer’s cohorts. However, the generalized survival estimates provided by traditional staging demonstrated superior predictive capability; therefore, AJCC TNM staging should remain the gold standard for the prognostication of resected NSCLC in the US.
Similar content being viewed by others
References
Howlader N, Noone AM, Krapcho M, et al. (eds). Cancer Statistics Review: 1975–2013. Bethesda, MD: National Cancer Institute; 2016.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: non-small cell lung cancer. Version 4.2016. Available at: www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed 28 Jan 2016.
Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual, 7th ed. New York: Springer; 2010.
Martini N, Burt ME, Bains MS, et al. Survival after resection of stage II non-small cell lung cancer. Ann Thorac Surg. 1992;54:460–465.
Bulzebruck H, Bopp R, Drings P, et al. New aspects in the staging of lung cancer. Prospective validation of the International Union Against Cancer TNM classification. Cancer. 1992;70:1102–110.
Williams DE, Pairolero PC, Danis CS, et al. Survival of patients surgically treated for stage I lung cancer. J Thorac Cardiovasc Surg. 1981;82:70–76.
Kawaguchi T, Takada M, Kubo A, et al. Performance status and smoking status are independent favorable prognostic factors for survival in non-small cell lung cancer: a comprehensive analysis of 26,957 patients with NSCLC. J Thorac Oncol. 2015;5:620–630.
Birim O, Kappetein AP, Waleboer M, et al. Long-term survival after non-small cell lung cancer surgery: development and validation of a prognostic model with a preoperative and postoperative mode. J Thorac Cardiovasc Surg. 2006;132:491–498.
Agarwal M, Brahmanday G, Chmielewski GW, et al. Age, tumor size, type of surgery, and gender predict survival in early stage (stage I and II) non-small cell lung cancer after surgical resection. Lung Cancer. 2010;68:398–402.
Chansky K, Sculier JP, Crowley JJ, et al. The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer. J Thorac Oncol. 2009;4:792–801.
Liang W, Zhang L, Jiang G, et al. Development and validation of a nomogram for predicting survival in patients with resected non-small-cell lung cancer. J Clin Oncol. 2015;33:861-869.
Liu L, Forman S, Barton B. Fitting the Cox model using PROC PHREG and Beyond in SAS. Presented at the SAS Global Forum, Washington, DC, 22-25 March 2009.
Klar M, Jochmann A, Foeldi M, et al. The MSKCC nomogram for prediction the likelihood of non-sentinel node involvement in a German breast cancer population. Breast Cancer Res Treat. 2008;112:523-531.
Smaletz O, Scher HI, Small EJ, et al. Nomogram for overall survival of patients with progressive metastatic prostate cancer after castration. J Clin Oncol. 2002;20:3972-3982.
Dransfield MT, Lock BJ, Garver RI Jr. Improving the lung cancer resection rate in the US Department of Veterans Affairs Health System. Clin Lung Cancer. 2006;7:268-272.
Gould MK, Ghaus SJ, Olsson JK, et al. Timeliness of care in veterans with non-small cell lung cancer. Chest. 2008;133:1167-1173.
Schultz EM, Powell AA, McMillan A, et al. Hospital characteristics associated with timeliness of care in veterans with lung cancer. Am J Respir Crit Care Med. 2009;179:595-600.
Yorio JT, Xie Y, Yan J, et al. Lung cancer diagnostic and treatment intervals in the United States: a health care disparity? J Thorac Oncol. 2009;4:1322-1330.
Quarterman RL, McMillan A, Ratcliffe MB, et al. Effect of preoperative delay on prognosis for patients with early stage non-small cell lung cancer. J Thorac Cardiovasc Surg. 2003;125:108-113.
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Young, K.A., Efiong, E., Dove, J.T. et al. External Validation of a Survival Nomogram for Non-Small Cell Lung Cancer Using the National Cancer Database. Ann Surg Oncol 24, 1459–1464 (2017). https://doi.org/10.1245/s10434-017-5795-5
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-017-5795-5