A prognostic model for elderly patients with squamous non-small cell lung cancer: a population-based study
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Journal of Translational Medicine Open Access
RESEARCH
A prognostic model for elderly patients with squamous non‑small cell lung cancer: a population‑based study Siying Chen, Chunxia Gao, Qian Du, Lina Tang, Haisheng You* and Yalin Dong*
Abstract Background: Squamous cell carcinoma (SCC) is a main pathological type of non-small cell lung cancer. It is common among elderly patients with poor prognosis. We aimed to establish an accurate nomogram to predict survival for elderly patients (≥ 60 years old) with SCC based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods: The gerontal patients diagnosed with SCC from 2010 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. The independent prognostic factors were identified using multivariate Cox proportional hazards regression analysis, which were utilized to conduct a nomogram for predicting survival. The novel nomogram was evaluated by Concordance index (C-index), calibration curves, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). Results: 32,474 elderly SCC patients were included in the analysis, who were randomly assigned to training cohort (n = 22,732) and validation cohort (n = 9742). The following factors were contained in the final prognostic model: age, sex, race, marital status, tumor site, AJCC stage, surgery, radiation and chemotherapy. Compared to AJCC stage, the novel nomogram exhibited better performance: C-index (training group: 0.789 vs. 0.730, validation group: 0.791 vs. 0.733), the areas under the receiver operating characteristic curve of the training set (1-year AUC: 0.846 vs. 0.791, 3-year AUC: 0.860 vs. 0.801, 5-year AUC: 0.859 vs. 0.794) and the validation set (1-year AUC: 0.846 vs. 0.793, 3-year AUC: 0.863 vs. 0.806, 5-year AUC: 0.866 vs. 0.801), and the 1-, 3- and 5-year calibration plots. Additionally, the NRI and IDI and 1-, 3- and 5-year DCA curves all confirmed that the nomogram was a great prognosis tool. Conclusions: We constructed a novel nomogram that could be practical and helpful for precise evaluation of elderly SCC patient prognosis, thus helping clinicians in determining the appropriate therapy strategies for individual SCC patients. Keywords: Nomogram, Squamous non-small cell lung cancer, Elderly patients, Survival prediction Background Lung cancer is the most frequent cause of cancer-related mortality in the world, with a 5-year survival of approximately 4–17% in populations [1, 2]. It is classified into two broad categories based on the different biological characteristics, treatment and prognosis: small cell lung *Correspondence: [email protected]; [email protected] Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 of Yanta West Road, Xi’an 710061, Shaanxi, China
cancer (SCLC, approximately 15% of all lung cancers) and non-small cell lung cancer (NSCLC, approximately 85% of all lung cancers) [3]. Among them, NSCLC is the most comm
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