Establishment Of Clinical Predictive Model Of Postoperative Recurrence Of Non-small Cell Lung Cancer In IA Stage

Background and ObjectiveCurrently,lung cancer is one of the most common malignancies in China,and it remains the leading cause of cancer-related death worldwide.Even for patients with pathologic stage IA non-small cell lung cancer(NSCLC),the recurrence after surgery is approximately 20%.So far there have been a lot of literature researched risk factors of postoperative recurrence in stage IA NSCLC,but for the patients' clinicl prediction model for postoperative recurrence has been rarely reported.The aim of this study is to investigate the risk factors of postoperative recurrence of non-small cell lung cancer(NSCLC)in IA stage,and draw a nomogram clinicl model.Materials and methods1.The retrospective study was conducted.The clinical data of 471 patients who underwent surgical resection and were diagnosed as IA stage by pathology between January 2008 and November 2012 in suzhou hospitals were collected.The clinicl data of patients were used for prognostic analysis.The follow-up using telephone interview and visit was performed to detect the postoperative recurrence of NSCLC in IA stage up to December 2017.2.The survival curve was drawn by the Kaplan—Meier method.Univariate and multivariate Cox regression analysis the value of factors in predicting the probability of NSCLC in IA stage.A risk model of postoperative recurrence of NSCLC in IA stage was built.The nomogram model and calibration curve of postoperative survival rate in 5 years were drawn according to the regression coefficients and other data of selected variables in the COX regression model.Results1.471 stage IA NSCLC patients into the study,including 90 cases with recurrence,The total recurrence rate of 471 patients with IA-stage NSCLC in 5 years after operation was 19.1%.2.Risk factors analysis affecting the postoperative recurrence of NSCLC in IA stage: In univariate Cox regression analysis,Sex(P=0.001),Age(P<0.001),Preoperative NLR(P<0.001),Preoperative serum CEA level(P=0.004),Differentiation degree(P<0.05),T stage(P<0.05),visceral pleural involvement(P<0.001)were significantly associated with postoperative recurrence of patients with IA stage NSCLC.In multivariate analysis,only Age>65 years old(P<0.001),the bigger the tumor(P<0.05),Preoperative NLR>2.5(P=0.011),Preoperative serum CEA level>2.5ng/ml(P=0.023),Low differentiation(P<0.05),visceral pleural involvement(P=0.013)retained independent significance.3.Through variable filtering,the final model includes Age,T stage,Preoperative NLR,Preoperative serum CEA level,Differentiation degree,visceral pleural involvement,and to draw a nomogram.The nomogram predicting the risk of postoperative recurrence of NSCLC in IA stage showed relative good concordance index(0.69)and good calibration.Conclusions1.Age>65 years old,the bigger the tumor,Preoperative NLR>2.5,Preoperative serum CEA level>2.5ng/ml,Low differentiation,visceral pleural involvement are independent risk factors affecting the postoperative recurrence of NSCLC in IA stage.2.The nomogram can assess the postoperative recurrence risk of this patients.This statistical tool may facilitate discussions at the point of treatment decision making.