Construction and validation of a novel web-based nomogram for patients with lung cancer with bone metastasis: A real-world analysis based on the SEER database

Mengchen Yin; Sisi Guan; Xing Ding; Ruoyu Zhuang; Zhengwang Sun; Tao Wang; Jiale Zheng; Lin Li; Xin Gao; Haifeng Wei; Junming Ma; Quan Huang; Jianru Xiao; Wen Mo

doi:10.3389/fonc.2022.1075217

Construction and validation of a novel web-based nomogram for patients with lung cancer with bone metastasis: A real-world analysis based on the SEER database

Front Oncol. 2022 Dec 9:12:1075217. doi: 10.3389/fonc.2022.1075217. eCollection 2022.

Authors

Mengchen Yin^{1

2}, Sisi Guan¹, Xing Ding¹, Ruoyu Zhuang¹, Zhengwang Sun³, Tao Wang⁴, Jiale Zheng¹, Lin Li², Xin Gao², Haifeng Wei², Junming Ma¹, Quan Huang², Jianru Xiao², Wen Mo¹

Affiliations

¹ Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
² Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China.
³ Department of Musculoskeletal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China.
⁴ Department of Orthopaedics, The Second Hospital of Anhui Medical University, Anhui, China.

Abstract

Purpose: Patients with lung cancer with bone metastasis (LCBM) often have a very poor prognosis. The purpose of this study is to characterize the prevalence and associated factors and to develop a prognostic nomogram to predict the overall survival (OS) and cancer-specific survival (CSS) for patients with LCBM using multicenter population-based data.

Methods: Patients with LCBM at the time of diagnosis were identified using the Surveillance, Epidemiology, and End Results (SEER) Program database of the National Cancer Institute (NCI) from 2010 to 2015. Multivariable and univariate logistic regression analyses were performed to identify factors associated with all-cause mortality and lung cancer (LC)-specific mortality. The performance of the nomograms was evaluated with the calibration curves, area under the curve (AUC), and decision curve analysis (DCA). Kaplan-Meier analysis and log-rank tests were used to estimate the survival times of patients with LCBM.

Results: We finally identified 26,367 patients with LCBM who were selected for survival analysis. Multivariate analysis demonstrated age, sex, T stage, N stage, grade, histology, radiation therapy, chemotherapy, primary site, primary surgery, liver metastasis, and brain metastasis as independent predictors for LCBM. The AUC values of the nomogram for the OS prediction were 0.755, 0.746, and 0.775 in the training cohort; 0.757, 0.763, and 0.765 in the internal validation cohort; and 0.769, 0.781, and 0.867 in the external validation cohort. For CSS, the values were 0.753, 0.753, and 0.757 in the training cohort; 0.753, 0.753, and 0.757 in the internal validation cohort; and 0.767, 0.774, and 0.872 in the external validation cohort.

Conclusions: Our study constructs a new prognostic model and clearly presents the clinicopathological features and survival analysis of patients with LCBM. The result indicated that the nomograms had favorable discrimination, good consistency, and clinical benefits in patients. In addition, our constructed nomogram prediction models may assist physicians in evaluating individualized prognosis and deciding on treatment for patients.

Keywords: SEER; bone metastases; cancer-specific survival; lung cancer; overall survival.