Survival Prediction Model Using Clinico-Pathologic Characteristics for Nonsmall Cell Lung Cancer Patients After Curative Resection

Abstract

The current TNM staging system did not provide disease relapse information. The aim of study was try to establish a predictive survival model for disease and overall survival in nonsmall cell lung cancer patients who presented as resectable disease and to develop a reference for follow-up imaging tool selection.From January 2005 to December 2011, 442 patients who initially presented as resectable disease (stages I-IIIa) and received anatomic resection and mediastinal lymph node dissection were included in the study.Medical charts were thoroughly reviewed and clinico-pathologic factors were collected and analyzed.Visceral pleural invasion, tumor size >5 cm, and postoperative adjuvant therapy were identified as risk factors for poorer disease-free survival. The 5-year disease-free survival from score 0 to 3 was 68.7%, 46.6%, 31.9%, and 26.1%, respectively. The disease relapse percentage for scores 0 to 3 were 26.49%, 50.61%, 65.05%, and 73.81%, respectively. For analysis of overall survival, age >60 years, tumor size >3 cm, and total metastatic lymph node ratio >0.05 were correlated to worse overall survival. Because greater age may be correlated with poor general condition, we re-scored risk factors that correlated to disease severity that ranging from 0 to 2. The 5-year overall survival range from score 0 to 2 was 56.3%, 43.1%, and 13.1%, respectively.Poor prognostic factors correlated to disease-free survival were tumor size >5 cm, visceral pleural invasion, and patients needing to receive postoperative adjuvant therapy. Disease-free survival of resectable nonsmall cell lung cancer patients and disease relapse can be stratified by these 3 factors. Chest tomography may be recommended for patients with 1 or more poor disease-free survival risk factors.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1

Management algorithm for patients with suspicious metastatic lesions.

FIGURE 2

Disease-free survival among stratified subgrouping with risk factors. (A) Disease-free survival curve of patients (8 groups). Group 1: Tumor size >5 cm; visceral pleura invasion (+), with postoperative adjuvant therapy; Group 2: Tumor size >5 cm; visceral pleura invasion (−), with postoperative adjuvant therapy; Group 3: Tumor size >5 cm; visceral pleura invasion (+), without postoperative adjuvant therapy; Group 4: Tumor size >5 cm; visceral pleura invasion (−), without postoperative adjuvant therapy; Group 5: Tumor size ≤5 cm; visceral pleura invasion (+), with postoperative adjuvant therapy; Group 6: Tumor size ≤5 cm; visceral pleura invasion (−), with postoperative adjuvant therapy; Group 7: Tumor size ≤5 cm; visceral pleura invasion (+), without postoperative adjuvant therapy; Group 8: Tumor size ≤5 cm; visceral pleura invasion (−), without postoperative adjuvant therapy. (B) Disease-free survival of patients (4 groups). Score 0: Patients with tumor size ≤5 cm, no visceral pleura invasion and without need of postoperation adjuvant therapy; Score 1: Patients has 1 of following risk factors, such tumor size >5 cm, visceral pleura invasion, the need of postoperative adjuvant therapy; Score 2: Patients has 2 of following risk factors, such tumor size >5 cm, visceral pleura invasion, the need of postoperative adjuvant therapy; Score 3: Patients with tumor size >5 cm, visceral pleura invasion and need postoperative adjuvant therapy.

FIGURE 3

Relapse percentage of each group.

FIGURE 4

Overall survival among stratified subgrouping with risk factors. (A) Stratified overall survival according to 3 risk factors, including age, tumor size, and total metastatic lymph node ratio (4 groups). (B) Stratified overall survival according to 2 risk factors, including tumor size and total metastatic lymph node ratio (3 groups).