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Exploring Stage I non-small-cell lung cancer: development of a prognostic model predicting 5-year survival after surgical resection.

Exploring Stage I non-small-cell lung cancer: development of a prognostic model predicting 5-year survival after surgical resection.

Authors :
Guerrera, Francesco
Errico, Luca
Evangelista, Andrea
Filosso, Pier Luigi
Ruffini, Enrico
Lisi, Elena
Bora, Giulia
Asteggiano, Elena
Olivetti, Stefania
Lausi, Paolo
Ardissone, Francesco
Oliaro, Alberto
Source :
European Journal of Cardio-Thoracic Surgery; Jun2015, Vol. 47 Issue 6, p1037-1043, 7p
Publication Year :
2015

Abstract

OBJECTIVES: Despite impressive results in diagnosis and treatment of non-small-cell lung cancer (NSCLC), more than 30% of patients with Stage I NSCLC die within 5 years after surgical treatment. Identification of prognostic factors to select patients with a poor prognosis and development of tailored treatment strategies are then advisable. The aim of our study was to design a model able to define prognosis in patients with Stage I NSCLC, submitted to surgery with curative intent. METHODS: A retrospective analysis of two surgical registries was performed. Predictors of survival were investigated using the Cox model with shared frailty (accounting for the within-centre correlation). Candidate predictors were: age, gender, smoking habit, morbidity, previous malignancy, Eastern Cooperative Oncology Group performance status, clinical N stage, maximum standardized uptake value (SUVmax), forced expiratory volume in 1 s, carbon monoxide lung diffusion capacity (DLCO), extent of surgical resection, systematic lymphadenectomy, vascular invasion, pathological T stage, histology and histological grading. The final model included predictors with P < 0.20, after a backward selection. Missing data in evaluated predictors were multiple-imputed and combined estimates were obtained from 10 imputed data sets. RESULTS: Analysis was performed on 848 consecutive patients. The median follow-up was 48 months. Two hundred and nine patients died (25%), with a 5-year overall survival (OS) rate of 74%. The final Cox model demonstrated that mortality was significantly associated with age, male sex, presence of cardiac comorbidities, DLCO (%), SUVmax, systematic nodal dissection, presence of microscopic vascular invasion, pTNM stage and histological grading. The final model showed a fair discrimination ability (C-statistic = 0.69): the calibration of the model indicated a good agreement between observed and predicted survival. CONCLUSIONS: We designed an effective prognostic model based on clinical, pathological and surgical covariates. Our preliminary results need to be refined and validated in a larger patient population, in order to provide an easy-to-use prognostic tool for Stage I NSCLC patients. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10107940
Volume :
47
Issue :
6
Database :
Complementary Index
Journal :
European Journal of Cardio-Thoracic Surgery
Publication Type :
Academic Journal
Accession number :
103100316
Full Text :
https://doi.org/10.1093/ejcts/ezu410