Prognostic score and sex-specific nomograms to predict survival in resectable lung cancer: A French nationwide study from the Epithor cohort database

Marco Alifano; Elisa Daffré; Laurent Brouchet; Pierre Emmanuel Falcoz; Françoise Le Pimpec Barthes; Pierre Benoit Pages; Pascal Alexandre Thomas; Marcel Dahan; Raphael Porcher

doi:10.1016/j.lanepe.2022.100566

Prognostic score and sex-specific nomograms to predict survival in resectable lung cancer: A French nationwide study from the Epithor cohort database

Lancet Reg Health Eur. 2022 Dec 19:26:100566. doi: 10.1016/j.lanepe.2022.100566. eCollection 2023 Mar.

Authors

Marco Alifano¹, Elisa Daffré¹, Laurent Brouchet², Pierre Emmanuel Falcoz³, Françoise Le Pimpec Barthes⁴, Pierre Benoit Pages⁵, Pascal Alexandre Thomas⁶, Marcel Dahan², Raphael Porcher^{7

8}

Affiliations

¹ Thoracic Surgery Department, Cochin Hospital, Université Paris Cité, Paris, France.
² Thoracic Surgery Department, Hôpital Larrey, CHU Toulouse, Paris, France.
³ Thoracic Surgery Department, Nouvel Hôpital Civil de Strasbourg, University of Strasbourg, Paris, France.
⁴ Thoracic Surgery Department, Hôpital Européen Georges Pompidou, Université Paris Cité, Paris, France.
⁵ Thoracic Surgery Department, Dijon University Hospital, Dijon, France.
⁶ Thoracic Surgery Department, Hopital-Nord-APHM, Aix-Marseille University, Marseille, France.
⁷ Centre de Recherche Épidémiologie et Statistiques (CRESS-UMR1153), INSERM, INRAE, Université Paris Cité, Paris, France.
⁸ Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Paris, France.

Abstract

Background: Prognostic assessment in patients undergoing cancer treatments is of paramount importance to plan subsequent management. In resectable lung cancer availability of an easy-to use nomogram to predict long-term outcome would be extremely useful to identify high-risk patients in the era of perioperative targeted and immune therapies.

Methods: We retrieved clinical, surgical and pathological data of all consecutive patients included in Epithor, the database of French Society of Thoracic and Cardiovascular Surgery, and operated on between 2003 and 2020 for non-small cell lung cancer in a curative intent. The primary endpoint was overall survival up to 5 years. We assessed prognostic significance of available variables using Cox modelling, in the whole dataset, and in men and in women separately, and performed temporal validation. Finally, we constructed two sex-specific nomograms. Survivals by fifths of score were assessed in the development and temporal validation sets.

Findings: The study included 62,633 patients (43,551 men and 19,082 women). Median survival time was 9.2 years. Nine factors had strong prognostic impact and were used to construct nomograms. The optimism-corrected c statistic for the prognostic score was 0.689 in the development sample, and 0.726 (95% CI 0.718-0.735) in the temporal validation sample. All differences between adjacent fifths of score were significant (P < 0.0001). Figures of 3-year OS by fifths of score were 92.2%, 83.0%, 74.3%, 64.0%, and 43.4%, respectively, in the development set and 93.3%, 88.4%, 81.0%, 73.7%, 55.7% in the temporal validation set. Performance of score was maintained when stratifying by stage of diseases.

Interpretation: In the present work, we report evidence that long-term overall survival after resection of NSCLC can be predicted by an easy to construct and use composite score taking into account both host and tumour related factors.

Funding: Epithor is funded by FSTCVS.

Keywords: Lung cancer; Nomogram; Outcome; Surgery; Survival.