Establishment Of A Predictive Model For Postoperative Recurrence Of Stage IB Non-Small Cell Lung Cancer And Analysis Of Its Predictive Value

Objective: To study the risk factors of postoperative recurrence in patients with stage IB non-small cell lung cancer and establish a recurrence prediction model,and to verify the feasibility of the model.Methods: According to the clinical characteristics and follow-up outcomes,postoperative stage for IB non-small cell lung cancer patients in our hospital during May 2010 to October 2014 were retrospectively analysed.Enter the follow-up data into the SPSS program.Kaplan-meier method was used to analyze the recurrence-free survival rate and draw a survival curve.All single factors affecting recurrence-free survival rate were analyzed using the log-rank method.Then compare the differences in recurrence-free survival rate of each single factor.Each single factor was further incorporated into the multivariate Cox regression analysis.Independent risk factors were screened out to establish the prediction model of postoperative recurrence,and the nomogram and calibation curve were drawn to determine the fitting degree.Results: There were 227 subjects in this study,including 143 men and 84 women,aged 39-80 years(mean age: 60.6 years),with an average follow-up of 60 months.Twenty-five patients relapsed after surgery in 5 years,and the recurrence rate was 11% in 5 years,including 6 patients relapsed in 1 year,10 patients relapsedin 2 years,8 patients relapsed in 3 years,and 1 patient relapsed in 4 years.Postoperative pathology showed 192 cases of adenocarcinoma,6 cases of adenosquamous carcinoma,1 case of epidermoid carcinoma,1 case of lymphoepithelial neoplasia,21 cases of squamous carcinoma,3 cases of mucinous adenocarcinoma,1 case of mucoepidermoid carcinoma,1 case of epithelial neoplasia,and 1 case of neuroendocrine carcinoma.Single factor analysis showed that gender(p=0.044<0.05),smoking habit(p=0.048<0.05),CEA(p=0.004<0.05),PLR(p=0.017<0.05),tumor maximum diameter (p=0.001<0.05),pathological type(p=0.02<0.05),micropapillarystructure(p=0.001<0.05),and visceral pleura involvement(p=0.006<0.05)were associated with postoperative recurrence of stage IB NSCLC.Further to include all the seven factors Cox regression analysis of multiple factors,the results showed that involvement of visceralpleura,pathological micropapillary structure,maximum tumor diameter,diameter,preoperative serum CEA level and pathological type are independent risk factors for postoperative recurrence of IB NSCLC(p< 0.05).The nomogram model was drawn according to the regression coefficients.Internal validation method and the validation results showed that the prediction model of calibration curve to distinguish the degree and consistency were good(C-index = 0.738).Conclusions: 1.Involvement of visceral pleura,pathological micropapillary structure,maximum tumor diameter,preoperative serum CEA level and pathological type were independent risk factors for recurrence of stage IB NSCLC;2.Adjuvant chemotherapy in stage IB NSCLC patients is not necessary;3.The histogram can individually predict the probability of postoperative recurrence of stage IB NSCLC patients;4.If the pathological type is mainly micropapillary structure,further studies are needed to confirm that the pathological subtype of micropapillary structure can be incorporated into the staging standard of TNM staging system in the future.