Nomogram for Predicting the Relationship between the Extent of Visceral Pleural Invasion and Survival in Non-Small-Cell Lung Cancer

Abstract

Objective: Although visceral pleural invasion (VPI) has already been incorporated into the TNM staging system, few studies have been conducted to evaluate the prognostic value of the extent of VPI for the survival of non-small-cell lung cancer (NSCLC) patients. Thus, we utilized the Surveillance, Epidemiology, and End Results (SEER) database to assess the correlation between the extent of VPI and survival in NSCLC.

Methods: We identified and incorporated the extent of VPI to build a prognostic nomogram in this study. Patients in the SEER database diagnosed with NSCLC (n = 87,045) from 2010 to 2015 were further analyzed and randomly assigned into either the training group (n = 60,933) or validation group (n = 26,112). Clinical variables were calculated by means of multivariate Cox regressions and incorporated into the predictive model. Subsequently, the accuracy and discrimination of nomogram were further assessed through the concordance index (C-index), calibration curves, and Kaplan-Meier curves.

Results: Multivariate analysis demonstrated that the extent of visceral pleural invasion was an independent and unfavorable prognostic factor. The C-indexes of the training and validation groups were 0.772 (95% CI: 0.770-0.774) and 0.769 (95% CI: 0.765-0.773), respectively, which revealed that the nomogram had sufficient credibility and stable predictive accuracy. The calibration curve displayed consistency between the actual and predictive values in both training and validation groups.

Conclusion: The prognostic nomogram with the extent of VPI could offer an accurate risk evaluation for patients with NSCLC. Independent external validation of this research should be conducted in the future.