Development and validation of a preoperative prognostic index independent of TNM stage in resected non-small cell lung cancer

BMC Pulm Med. 2017 Dec 4;17(1):166. doi: 10.1186/s12890-017-0529-9.

Abstract

Background: Previously reported prognostic tools for patients with resected non-small cell lung cancer (NSCLC) include factors found postoperatively, but not preoperatively. However, it would be important to predict patient prognosis before NSCLC resection. To suggest a novel preoperative prognostic tool, we evaluated the relationship of preoperative prognostic factors with the survival of patients with resected NSCLC.

Methods: We retrospectively reviewed the data of two independent cohorts of patients with completely resected NSCLC. To develop the prognostic index in one cohort, the overall survival (OS) was evaluated using the Cox proportional hazards model. We assessed the disease-free survival (DFS) and OS of three risk groups defined according to the prognostic index. Then, the prognostic index was validated in the other cohort.

Results: Seven independent risk factors for OS were selected: age ≥ 70 years, ever-smokers, vital capacity <80%, neutrophil-to-lymphocyte ratio ≥ 2.1, cytokeratin 19 fragment >normal limit, non-usual interstitial pneumonia (UIP) pattern, and UIP pattern. Three risk groups were defined: low-risk (36.9%), intermediate-risk (54.0%), and high-risk (9.1%). In the derivation cohort, the 5-year DFS rate was 77.8%, 58.8%, and 22.6% (P < 0.001), and the 5-year OS rate was 95.2%, 70.4%, and 28.9% (P < 0.001), respectively. Multivariate analyses showed that the prognostic index predicted DFS and OS, independent of pathological stage and tumor histology, in both derivation and validation cohorts.

Conclusions: We developed and validated a simple preoperative prognostic index composed of seven variables, which may help clinicians predict prognosis before surgery in patients with NSCLC.

Keywords: Curative resection; Disease-free survival; Non-small cell lung cancer; Overall survival; Preoperative prognostic factors.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / complications
  • Carcinoma, Non-Small-Cell Lung / physiopathology
  • Carcinoma, Non-Small-Cell Lung / secondary
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Disease-Free Survival
  • Female
  • Humans
  • Idiopathic Pulmonary Fibrosis / complications
  • Keratin-19 / blood
  • Lung Neoplasms / complications
  • Lung Neoplasms / pathology
  • Lung Neoplasms / physiopathology
  • Lung Neoplasms / surgery*
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Neutrophils
  • Peptide Fragments / blood
  • Predictive Value of Tests
  • Preoperative Period
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Smoking
  • Survival Rate
  • Vital Capacity
  • Young Adult

Substances

  • Keratin-19
  • Peptide Fragments