Development and Validation of a Novel Nomogram for Predicting Tumor-Distant-Metastasis in Patients with Early T1-2 Stage Lung Adenocarcinoma

WeiGuo Gu; MingBin Hu; WeiJia Wang; Chao Shi; JinHong Mei

doi:10.2147/TCRM.S272748

Development and Validation of a Novel Nomogram for Predicting Tumor-Distant-Metastasis in Patients with Early T1-2 Stage Lung Adenocarcinoma

Ther Clin Risk Manag. 2020 Dec 10:16:1213-1225. doi: 10.2147/TCRM.S272748. eCollection 2020.

Authors

WeiGuo Gu^{1

2}, MingBin Hu^{1

2}, WeiJia Wang¹, Chao Shi³, JinHong Mei¹

Affiliations

¹ Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
² First Clinical Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China.
³ Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.

Abstract

Background: Distant metastasis in early T1-2 (diameter≤5 cm) stage lung adenocarcinoma (ET-LUAD) patients largely affect treatment strategies in clinical practice. However, the associated mechanism remains unclear and related studies is less. This study aimed to establish and validate a novel nomogram to predict the risk of distant metastasis in ET-LUAD.

Methods: A total of 258 patients diagnosed with ET-LUAD and not receiving any treatment were recruited into this study. The patients were randomly divided into a training cohort and validation cohort in a ratio of 1:2. Univariate and multivariate logistic regression analysis was used to select the most significant predictive risk factors associated with distant metastasis in the training cohort. The established nomogram was validated by the consistency index (C-index), calibration curve, and decision curve analysis (DCA).

Results: There were 124 patients with confirmed distant metastasis and 134 patients with non-distant metastases ET-LUAD were enrolled in the study. Multivariate logistic hazards regression analysis identified independent risk factors associated with distant metastasis to include platelet-to-lymphocyte ratios (PLR), lactate dehydrogenase (LDH), neural-specific enolase (NSE), carcinoembryonic antigen (CEA) and cytokeratin 19 fragments (Cyfra211), which were included in the establishment of the nomogram. The nomogram achieved a high consistency (C-index=0.792), good calibration, and high clinical application value in the validation cohort.

Conclusion: The established nomogram can be used to predict distant metastasis in high-risk ET-LUAD nonmetastasis patients and can also be used by doctors to guide preventive and individualized treatment for ET-LUAD patients.

Keywords: distant metastasis; lung adenocarcinoma; nomogram.

Grants and funding

This work was supported by the National Natural Science Foundation of China (grant number 81560410 to JH Mei). The funding sources had no role in the data collection, analysis or interpretation.