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Development and validation of a nomogram for predicting cancer‐specific survival of surgical resected stage I‐II adenosquamous carcinoma of the lung
Author(s) -
Li Hao,
Wang Zhenfan,
Yang Fan,
Wang Jun
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25858
Subject(s) - nomogram , medicine , stage (stratigraphy) , t stage , cohort , concordance , lung cancer , lymphadenectomy , adenosquamous carcinoma , oncology , surgery , cancer , adenocarcinoma , paleontology , biology
Objectives Primary lung adenosquamous carcinoma (ASC) is a rare cancer subtype and has a poor prognosis. The prognostic factors for resected early‐stage ASC remain unclear. We aimed to develop a nomogram to predict lung cancer‐specific survival (LCSS) of patients undergoing surgical resection for stage I‐II ASC. Methods Data of patients undergoing resection for stage I‐II ASC and diagnosed between 2004‐2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. All the included patients were randomized at a 7:3 ratio into a training and a validation cohort. We selected and integrated significant prognostic factors based on competing for risk regression to build a nomogram. The performance of the nomogram was evaluated using Harrell's concordance index (C‐index) and calibration plots. Results A total of 988 patients (530 men and 458 women) undergoing surgical resection for stage I‐II ASC were identified and randomized into a training (692, 70%) cohort and a validation cohort (296, 30%). The baseline characteristics were similar in the training and validation cohorts. Age, T stage, N stage, and the number of examined lymph nodes were independent prognostic factors for LCSS and were used in the nomogram. The calibration plots showed that the 3‐ and 5‐year LCSS probabilities were consistent between the nomogram prediction and the actual observation. The C‐index of the nomogram was 0.671 (95%CI: 0.618‐0.724) and 0.635 (95%CI: 0.557‐0.713) in the training cohort and validation cohort, respectively. We developed a risk classification system based on the nomogram to stratify patients into high‐ and low‐risk of cancer‐specific death groups. Patients with a similar risk shared similar prognostic prediction regardless of the stage category and patients with the same risk shared similar prognoses despite the different stage category. Conclusions We developed a competing risk nomogram to reliably predict cancer‐specific survival of patients undergoing surgical resection for stage I‐II ASC. The nomogram might be a useful tool to identify patients undergoing surgical resection for ASC who could be suitable candidates for adjuvant chemotherapy.