Prognostic Nomogram to Predict Survival after Surgery for Synchronous Multiple Lung Cancers in Multiple Lobes
Menée à partir de données portant sur 467 patients présentant plusieurs cancers primitifs synchrones du poumon non à petites cellules avec atteinte de plusieurs lobes pulmonaires, cette étude évalue la performance d'un nomogramme, basé notamment sur le type histologique des tumeurs, l'âge et le sexe des patients, pour prédire la survie après traitement chirurgical
Introduction : In the absence of metastatic disease, surgery for synchronous non-small cell lung cancers involving multiple lobes can be curative. However, there currently exists no reliable prognostic instrument for this patient population after surgery. We undertook an analysis to examine the prognostic significance of adenocarcinoma histology and developed a prognostic nomogram.
Methods: This study was a pooled analysis of 6 previously reported datasets. Patients without extra-thoracic metastasis who underwent surgical resection of synchronous lung cancers in multiple lobes were included. Those with small cell cancer, carcinoid tumor or exclusively carcinoma in-situ were excluded. A multivariable Cox-proportional hazards regression model was fitted to identify independent survival predictors for nomogram development.
Results: Data from 467 patients were analyzed. Adenocarcinoma was a sole histology in 253 patients (54.2%). Those with exclusively adenocarcinoma histology had a better median survival than their counterparts: 67.4 vs. 36.2 months, (p<0.001). Multivariable analysis incorporating histology, sex, age, maximal T-size, highest N-stage, and laterality demonstrated that having exclusively adenocarcinoma histology independently predicted an improved survival: hazard ratio 0.61 (95% CI: 0.48, 0.78). Other favorable survival predictors were N0, T-size <=3 cms, bilateral cancers, age <70 years, and female sex. The developed nomogram was well calibrated and demonstrated a moderate to good discrimination with a bootstrap-corrected Harrell C-statistic of 0.70.
Conclusion: Several unique features among patients with resected synchronous multiple lung cancers, including the presence of exclusively adenocarcinoma histology, are of prognostic significance. A simple nomogram incorporating these factors can be utilized to predict patient survival with acceptable accuracy.
Journal of Thoracic Oncology , résumé, 2013