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A Nomogram for Predicting Cancer-Specific Survival of TNM 8th Edition Stage I Non-small-cell Lung Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Models for predicting the survival outcomes of stage I non-small-cell lung cancer (NSCLC) defined by the newly released 8th edition TNM staging system are scarce. This study aimed to develop a nomogram for predicting the cancer-specific survival (CSS) of these patients and identifying individuals with a higher risk for CSS.

Methods

A total of 30,475 NSCLC cases were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We identified and integrated the risk factors to build a nomogram. The model was subjected to bootstrap internal validation with the SEER database, and external validation with a multicenter cohort of 1133 patients from China. The difference in the impact of adjuvant chemotherapy on model-defined high- and low-risk patients was examined using the National Cancer Database (NCDB).

Results

Eight independent prognostic factors were identified and integrated into the model. The calibration curves showed good agreement. The concordance index (C-index) of the nomogram was higher than that of the staging system (IA1, IA2, IA3, and IB) (internal validation set 0.63 vs. 0.56; external validation set 0.66 vs. 0.55; both p < 0.01). Specifically, 21.7% of stage IB patients (7.5% of all stage I) were categorized into the high-risk group (score > 30). There was a significant interaction effect between the adjuvant chemotherapy and risk groups in the NCDB cohort (p = 0.003).

Conclusions

We established a practical nomogram to predict CSS for 8th edition stage I NSCLC. A prospective study is warranted to determine its role in identifying adjuvant chemotherapy candidates.

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Funding

This study was supported by the China State Key Laboratory of Respiratory Disease Independent Subject (Grant No. SKLRD-QN-201925); China National Science Foundation (Grant Nos. 81871893 and 81501996); Key Project of Guangzhou Scientific Research Project (Grant Nos. 201804020030); high-level university construction project of Guangzhou Medical University (Grant Nos. 20182737, 201721007, 201715907, and 2017160107); and the National Key R & D Program (Grant Nos. 2017YFC0907903 and 2017YFC0112704).

Author information

Author notes

  1. Yuan Zeng, Nicholas Mayne, and Chi-Fu Jeffrey Yang have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China

    Yuan Zeng MD, Jun Liu MD, Yang Liu MD, Weizhe Huang MD, Jiaxi He MD, Wei Wang MD, Long Jiang MD, Fei Cui MD, Wenjun Wang MD, Wenhua Liang MD & Jianxing He PhD, MD

  2. Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, Guangdong Province, People’s Republic of China

    Yuan Zeng MD, Jun Liu MD, Yang Liu MD, Weizhe Huang MD, Jiaxi He MD, Wei Wang MD, Long Jiang MD, Fei Cui MD, Wenjun Wang MD, Wenhua Liang MD & Jianxing He PhD, MD

  3. Section of General Thoracic Surgery, Duke University Medical Center, Durham, NC, USA

    Nicholas Mayne MD, Chi-Fu Jeffrey Yang MD & Thomas A. D’Amico MD

  4. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong

    Calvin S. H. Ng MD

  5. Division of Thoracic Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan

    Chia-chuan Liu MD

  6. Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark

    René Horsleben Petersen MD

  7. Division of Thoracic Surgical Oncology, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Naples, Italy

    Gaetano Rocco MD

  8. Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK

    Alessandro Brunelli MD

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  1. Yuan Zeng MD
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  18. Wenhua Liang MD
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  19. Jianxing He PhD, MD
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the AME Thoracic Surgery Collaborative Group

Contributions

Conception and design: Jianxing He, Yuan Zeng, Wenhua Liang. Collection and assembly of data: Jianxing He, Yuan Zeng, Wenhua Liang, Nicholas Mayne, Chi-Fu Jeffrey Yang. Data analysis and interpretation: All authors. Manuscript preparation: All authors. Manuscript proofing: All authors. Final approval of the manuscript. All authors.

Corresponding authors

Correspondence to Wenhua Liang MD or Jianxing He PhD, MD.

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Zeng, Y., Mayne, N., Yang, CF.J. et al. A Nomogram for Predicting Cancer-Specific Survival of TNM 8th Edition Stage I Non-small-cell Lung Cancer. Ann Surg Oncol 26, 2053–2062 (2019). https://doi.org/10.1245/s10434-019-07318-7

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