Risk Factors Analysis And Prediction Model Of Postoperative Recurrence In Patients With Non-Small Cell Lung Cancer

Objective(s):The treatment of patients with early and mid-stage non-small cell lung cancer is mainly dependent on surgery,but the postoperative recurrence rate is still high,so we need to pay attention to the risk factors that influence the recurrence of this disease.In this study,a retrospective multi-factor analysis was used to explore the risk factors affecting postoperative recurrence in patients with non-small cell lung cancer.Based on these risk factors,a multi-factor regression prediction model was established in order to screen out high-risk patients,guide clinical intervention in advance and close follow-up of high-risk patients with postoperative recurrence of non-small cell lung cancer,reduce the recurrence rate and improve the prognosis of patients.Methods: This study is a retrospective analysis.Patients who underwent lung tumor resection in the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 and were pathologically diagnosed as non-small cell lung cancer after surgery were followed up by telephone,consulted the patient’s outpatient medical records and the patient’s re-hospitalization medical records.A total of 335 patients with exclusion,loss of follow-up,death due to other factors,complicated lung diseases,postoperative targeted therapy and radiotherapy were selected.The contents were recorded as follows:(1)Demographic characteristics,including age,gender,smoking history,etc.;(2)Pathological features and surgical conditions: tumor size,tumor site,resection method,regional lymph node metastasis,number of lymph node dissection,pleural invasion,lymphatic canal invasion;(3)Postoperative pathological types and stages;(4)The results of serum tumor markers included carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CYFRA21-1)and gastrin-releasing peptide precursor(Pro GRP).(5)Blood routine includes platelet count(PLT),neutrophil count(NEU)and lymphocyte count(LYM).SII is calculated by platelet count × neutrophil count/lymphocyte count.There were 107 cases in the relapse group.There were 228 cases in the group without recurrence.Data management and statistical analysis methods SAS9.4 and R4.2 software were used for single factor analysis.Qualitative data were described by n(%).For the data obeying normal distribution,use to describe.Without special instructions,the test level α is set to 0.05.In this study,ROC curve analysis was adopted for continuous variables to calculate the critical value when the area under the ROC curve was maximum,and patients were divided into two groups according to the critical value.Continuous variables such as age,CEA,CYFRA21-1,Pro GRP,SII,PLT,NEU,LYM,tumor size and lymph node dissection were grouped by optimal scale regression method.Continuous data is reported as the median of the quartile range.The cumulative recurrence rates of 1 year,3 years and 5 years were calculated.The survival curves of cumulative recurrence rates were described by Kaplan-Meier method,and the median survival time and 95% confidence interval(CI)were calculated.Univariate Cox regression analysis was used to compare the cumulative recurrence rates of patients with different characteristics.P value ≤0.05(test level α was set at 0.05)was considered statistically significant.Statistically significant variables were used in multivariate analysis of the Cox proportional risk regression model to determine independent risk factors for recurrence.Results: A total of 335 patients with non-small cell lung cancer were included in this study by Logistic regression analysis after 3 to 5 years of follow-up.Among them,107 patients relapsed and 73 died,with a recurrence rate of 31.9%.Among the patients with recurrence,the mortality rate was 68.2% and the 3-5-year survival rate was 78.2%.Chi-square test analysis showed that gender,smoking,tumor site,number of lymph node dissection,operative method and Pro GRP were not the risk factors for postoperative recurrence in non-small cell lung cancer patients.Age,tumor size,pathological type,TNM stage,lymphatic vessel invasion,pleural invasion,regional lymph node metastasis,chemotherapy,CEA,Cyfra21-1 and SII were 11 risk factors for postoperative recurrence in patients with non-small cell lung cancer(P<0.05).All the above significant univariate indicators were included in regression analysis,and it was found that age,primary tumor size,TNM stage,chemotherapy and SII were important factors affecting postoperative recurrence in patients with non-small cell lung cancer,and there were significant differences among these factors,with statistical significance(P<0.05).The above risk factors can be used to construct a prognostic model with a histogram to predict the recurrence free survival rate of patients with non-small cell lung cancer.Conclusion(s):This study showed that age,primary tumor size,TNM stage,SII and other four factors were risk factors for postoperative recurrence in patients with non-small cell lung cancer.Based on the above risk factors,a linear prognosis model was constructed to predict the postoperative recurrence-free survival rate in patients with non-small cell lung cancer.The histogram model can individually predict the recurrence probability of non-small cell lung cancer.