A nomogram to predict the recurrence-free survival and analyze the utility of chemotherapy in stage IB non-small cell lung cancer

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Abstract

Background

Large part of patients of stage IB non-small cell lung cancer (IB NSCLC) may suffer recurrence after surgery. This study is to determine risk factors and establish a nomogram for postoperative recurrence and to provide a reference for adjuvant chemotherapy selection in patients with stage IB NSCLC.

Methods

A total of 394 patients with postoperative stage IB NSCLC who visited Fujian Medical University Union Hospital between January 2010 and June 2016 were selected. Patients were divided into training and validation cohorts based on the time of diagnosis. Independent risk factors were identified using a Cox proportional hazards regression model. A nomogram was created to predict recurrence-free survival (RFS) and was validated with an independent cohort. The predictive ability of the nomogram was evaluated using the concordance index (C-index) and calibration curve. RFS between the high- and low-risk groups was determined using Kaplan-Meier curves, and subgroup analysis of chemotherapy was performed.

Results

Visceral pleura invasion, micropapillary structures, tumor size, preoperative serum carcinoembryonic antigen (CEA) level, preoperative serum cytokeratin-19 fragments (Cyfra21-1) level, and postoperative histology were identified as independent risk factors for stage IB NSCLC recurrence. Discrimination of the nomogram showed good prognostic accuracy and clinical applicability, with a C-index of 0.827 and 0.866 in the training and validation cohorts, respectively. The difference in RFS between the high- and low-risk groups in both cohorts was significant (P<0.05). Finally, a significant difference was observed on whether high-risk group should accept postoperative chemotherapy (P<0.05).

Conclusions

This nomogram can predict postoperative recurrence probability in patients with stage IB NSCLC, and can select patients with risk factors who need adjuvant chemotherapy.

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Most cited references 35

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Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

Ahmedin Jemal, Lindsey A Torre, Rebecca Siegel … (2018)

This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.

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X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization.

Robert Camp, Marisa Dolled-Filhart, David Rimm (2004)

The ability to parse tumors into subsets based on biomarker expression has many clinical applications; however, there is no global way to visualize the best cut-points for creating such divisions. We have developed a graphical method, the X-tile plot that illustrates the presence of substantial tumor subpopulations and shows the robustness of the relationship between a biomarker and outcome by construction of a two dimensional projection of every possible subpopulation. We validate X-tile plots by examining the expression of several established prognostic markers (human epidermal growth factor receptor-2, estrogen receptor, p53 expression, patient age, tumor size, and node number) in cohorts of breast cancer patients and show how X-tile plots of each marker predict population subsets rooted in the known biology of their expression.

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Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer.

Rodrigo Arriagada, Bengt Bergman, Ariane Dunant … (2004)

On the basis of a previous meta-analysis, the International Adjuvant Lung Cancer Trial was designed to evaluate the effect of cisplatin-based adjuvant chemotherapy on survival after complete resection of non-small-cell lung cancer. We randomly assigned patients either to three or four cycles of cisplatin-based chemotherapy or to observation. Before randomization, each center determined the pathological stages to include, its policy for chemotherapy (the dose of cisplatin and the drug to be combined with cisplatin), and its postoperative radiotherapy policy. The main end point was overall survival. A total of 1867 patients underwent randomization; 36.5 percent had pathological stage I disease, 24.2 percent stage II, and 39.3 percent stage III. The drug allocated with cisplatin was etoposide in 56.5 percent of patients, vinorelbine in 26.8 percent, vinblastine in 11.0 percent, and vindesine in 5.8 percent. Of the 932 patients assigned to chemotherapy, 73.8 percent received at least 240 mg of cisplatin per square meter of body-surface area. The median duration of follow-up was 56 months. Patients assigned to chemotherapy had a significantly higher survival rate than those assigned to observation (44.5 percent vs. 40.4 percent at five years [469 deaths vs. 504]; hazard ratio for death, 0.86; 95 percent confidence interval, 0.76 to 0.98; P<0.03). Patients assigned to chemotherapy also had a significantly higher disease-free survival rate than those assigned to observation (39.4 percent vs. 34.3 percent at five years [518 events vs. 577]; hazard ratio, 0.83; 95 percent confidence interval, 0.74 to 0.94; P<0.003). There were no significant interactions with prespecified factors. Seven patients (0.8 percent) died of chemotherapy-induced toxic effects. Cisplatin-based adjuvant chemotherapy improves survival among patients with completely resected non-small-cell lung cancer. Copyright 2004 Massachusetts Medical Society

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Author and article information

Journal

Journal ID (nlm-ta): Transl Lung Cancer Res

Journal ID (iso-abbrev): Transl Lung Cancer Res

Journal ID (publisher-id): TLCR

Title: Translational Lung Cancer Research

Publisher: AME Publishing Company

ISSN (Print): 2218-6751

ISSN (Electronic): 2226-4477

Publication date (Print and electronic): January 2022

Publication date (Print): January 2022

Volume: 11

Issue: 1

Pages: 75-86

Affiliations

[1 ]deptDepartment of Thoracic Surgery , Fujian Medical University Union Hospital , Fuzhou, China;

[2 ]deptKey Laboratory of Cardio-Thoracic Surgery (Fujian Medical University) , Fujian Province University , Fuzhou, China;

[3 ]Shanghai Tongshu Biotechnology Co., Ltd. , Shanghai, China;

[4 ]deptDepartment of Thoracic and Cardiovascular Surgery , The Second Affiliated Hospital of Fujian Medical University , Fuzhou, China;

[5 ]Fujian Medical University , Fuzhou, China;

[6 ]Department of Medical Oncology, Evang. Kliniken Essen-Mitte , Essen, Germany;

[7 ]deptInstitute of Pathology , University Medical Center , Göttingen, Germany;

[8 ]deptDepartment of Radiotherapy , Military Institute of Medicine , Warsaw, Poland;

[9 ]deptDepartment of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center , Nuernberg General Hospital , Nuremberg, Germany;

[10 ]Paracelsus Medical University Nuremberg , Nuremberg, Germany;

[11 ]deptDepartment of Radiation Oncology, Institut Jules Bordet , Université Libre Bruxelles , Brussels, Belgium

Author notes

Contributions: (I) Conception and design: J Lin, M Kang; (II) Administrative support: M Kang; (III) Provision of study materials or patients: Z Zhang, ZN Hong, S Xie, C Yang; (IV) Collection and assembly of data: ZN Hong, S Xie, C Yang; (V) Data analysis and interpretation: ZN Hong, S Xie, C Yang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

[#]

These authors contributed equally to this work and should be considered as co-first authors.

[*]

These authors contributed equally to this work and should be considered as co-corresponding authors.

Correspondence to: Mingqiang Kang, MD. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China. Email: zzycurry24@ 123456sina.com ; Jiangbo Lin, MD. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China. Email: jiangbolin8009@ 123456sina.com .

[^]

ORCID: 0000-0001-5716-6472.

Article

Publisher ID: tlcr-11-01-75

DOI: 10.21037/tlcr-21-1038

PMC ID: 8825662

PubMed ID: 35242629

SO-VID: 36f454d3-ee1e-48bf-acd3-712e02a46509

License:

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

A nomogram to predict the recurrence-free survival and analyze the utility of chemotherapy in stage IB non-small cell lung cancer

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Abstract

Background

Methods

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Conclusions

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Most cited references 35

Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization.

Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer.

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