Establishment And Significance Of Prognosis Prediction Model In Patients With T1-2N0M0 Stage NSCLC After Surgical

Objective:Lung cancer(LC)is the malignancy with the highest morbidity and mortality in the world.Non-small cell lung cancer(NSCLC)accounts for about 85%of patients with non-lung cancer.With the popularity of early screening and improvement of detection means,the early non-small cell lung cancer patients accounted for more and more high,however,early postoperative non-small cell lung cancer patients are still has a high percentage of recurrence and metastasis,causing poor prognosis of patients,to explore the factors affecting the prognosis of patients,to assist the prognosis of patients with early assessment,and timely medical intervention,so as to improve the prognosis of patients;To evaluate the role of chemotherapy in the prognosis of patients,and to explore specific markers suitable for chemotherapy population.In this study,medical records of NSCLC patients treated in Qilu Hospital from January 2014 to December 2016 were collected.All patients underwent radical surgical treatment with postoperative staging of T1-2N0M0.Patients were followed up for their recurrence and survival 5 years after surgery,so as to construct a prognosis prediction model for early NSCLC patients.The effect of postoperative adjuvant chemotherapy on the prognosis of patients was preliminarily evaluated.Methods:1.Patients with non-small cell lung cancer admitted to Qilu Hospital of Shandong University from January 2014 to December 2016 were searched in the medical record system.All patients underwent radical surgical treatment,and the postoperative pathological stages were T1-2N0M0.2.Collect clinical data of patients.Baseline data:including age,sex,smoking status,complications,family history,etc.;Tumor related:pathological type,gene mutation,surgical method,resection range,tumor location,whether accompanied by visceral pleural invasion,postoperative adjuvant chemotherapy,etc.;Laboratory indicators:blood routine,liver and kidney function,blood coagulation,tumor markers and other data;Imaging findings,such as lobulation,burr,pleural thickening,pleural traction,etc.3.Follow-up was conducted for all patients to pay attention to their survival and recurrence.4.All data were summarized and statistically analyzed,and all factors were included in the univariate Cox regression model;The factors with statistical significance were screened out and then multivariate regression analysis was carried out.at the same time draw the survival curve;Finally,the prognostic factors of stage T1-2N0M0 NSCLC patients were constructed using R language,and Normogram was drawn.The effect of adjuvant chemotherapy on the prognosis of patients was preliminarily evaluated,we also explored the indicators with guiding significance of chemotherapy.Results:1.A total of 411 patients with postoperative stage T2N0M0 NSCLC were enrolled in this study,including 244 males(52%)and 177 females(48%);The mean age was 60.5±9.5 years.The median follow-up time of all patients was 34 months(1-86 months),and the median survival time of all patients was 72 months(95%CI,67-76 months),with the shortest duration of 3 months and the longest duration of 86 months.Eighty-seven patients(21.2%)reached the primary study endpoint(death),and 127 patients(30.9%)reached the secondary study endpoint with recurrence and metastasis..2.Cox regression analysis was conducted on all the included numerical variables and classified variables,and univariate analysis showed that:Age of>63 years,VPI,tumor diameter of>3cm,Hcy>16.2umol/L,Cys-C>0.96mmol/L,alb<42.4g/L,no postoperative chemotherapy,and high NSE were associated with disease-free survival(DFS).>63 years old,tumor diameter>2.3cm,VPI,albumin<42.4g/L,Hcy>16.2umol/L,Cys-C>0.96mmol/L,CYFRA21-1>2.55ng/mL,no postoperative chemotherapy,pleural thickening,low tumor differentiation,NSE>12.5ng/mL These factors were correlated with overall survival(OS);3.Multivariate Cox regression analysis showed that combined VPI,albumin<42.4g/L,Hcy>16.2umol/L,Cys-C>0.96mmol/L,and CYFRA21-1>2.55ng/mL were correlated with OS.Tumor diameter>3cm,combined with VPI,Hcy>16.2umol/L,and Cys-C>0.96mmol/LNse>12.5ng/mL were associated with DFS in NSCLC patients.4.The survival curves were ploted by GraphPad Prism.The results showed that VPI,Hcy>16.2umol/L,Cys-C>0.96mmol/L,CYFRA21-1>2.55ng/mL,and albumin<42.4g/L were associated with decreased OS.Tumor diameter>3cm,combined with VPI,Hcy>16.2umol/L,Cys-C>0.96mmol/L,and NSE>12.5ng/mL were associated with DFS in T1-2N0M0 NSCLC patients.5.R language is used to construct the Normograph to predict the probability of recurrence and death of individuals.The C-index of DFS was 0.63,and that of OS was 0.62.6.Patients in the chemotherapy group were divided into two groups according to whether the levels of Hcy and Cys-C were increased.The OS and DFS of Hcy>16.2umol/L and Cys-C>0.96mmol/L group were significantly decreased,P<0.05,the difference was statistically significant.Patients in Hcy>16.2umol/L and Cys-C>0.96mmol/L groups were grouped according to whether or not they received chemotherapy.The concurrent survival analysis results showed that chemotherapy was correlated with DFS,but not with OS.Conclusion:1.Increased levels of VPI and Hcy(>16.2umol/L),increased levels of Cys C(>0.96mmol/L),decreased levels of ALB(<42.4g/L),and increased levels of CYFRA21-1(>2.55ng/mL)were independently associated with OS in T1-2N0M0 stage NSCLC patients.2.VPI,large tumor size(>3cm in diameter),elevated Hcy level(>16.2umol/L),elevated Cys-C and NSE level(>0.96mmol/L),and elevated NSE(>12.5ng/mL)were independently correlated with DFS in T1-2N0M0 stage NSCLC patients.3.A prediction model for the prognosis of T1-2N0M0 stage NSCLC patients is established,which is conducive to the individualized assessment of the risk of recurrence and death of patients.4.In the chemotherapy group,the postoperative DFS and OS of the high Hcy and high Cys-C groups were shorter than those of the low level group;In the patients with high Hcy and high Cys-C groups,the DFS of the patients in the chemotherapy group was longer than that without chemotherapy,while the overall survival was not significantly improved.5.Hcy and Cys-C can be used as guiding factors to help judge whether T1-2N0M0 stage NSCLC patients need adjuvant chemotherapy.