Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, School of Basic Medical Science, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China.
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, School of Basic Medical Science, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China.
Asian J Surg. 2022 Dec;45(12):2691-2699. doi: 10.1016/j.asjsur.2022.01.010. Epub 2022 Feb 10.
This study aimed to construct a nomogram to effectively predict recurrence and metastasis in patients with stage 1A lung adenocarcinoma after video-assisted thoracoscopic surgery (VATS) lobectomy.
Our study included 337 patients. The 3-year recurrence-free survival rate and the 5-year recurrence-free survival (5-RFS) rate were analyzed. Multivariate Cox proportional hazards regression was conducted to identify independent risk factors. We established a nomogram and performed Harrell's Concordance index, calibration plots, integrated discrimination improvement, and decision curve analyses to assess its discrimination and calibration.
The median follow-up time was 45 months. In a multivariate analysis, tumor diameter, pathological subtype, preoperative carcinoembryonic antigen level, and preoperative CYFRA21-1 level were independent prognostic factors for RFS (P < 0.05). These risk factors were used to construct a nomogram to predict postoperative recurrence and metastasis in these patients. Internal verification was performed using the bootstrap method. The C-index was 0.946 (95% confidence interval: 0.923-0.970), indicating that the model had a good predictive performance. Using the nomogram and X-tile software, the patients were divided into two groups: the high-risk (5-RFS rate, 0.10-0.90) and low-risk groups (5-RFS rate, 0.90-0.99); the difference in the RFS rate between the groups was significant (χ2 = 86.705, P < 0.001).
Our nomogram had a better predictive ability for recurrence and metastasis in patients with stage 1A lung adenocarcinoma after VATS lobectomy resection than the Tumor-Node-Metastasis staging system and other predictive models. This nomogram can help provide individualized treatment strategies and follow-up times.
本研究旨在构建一个列线图，以有效预测接受电视辅助胸腔镜手术（VATS）肺叶切除术后 1A 期肺腺癌患者的复发和转移。
本研究纳入了 337 例患者。分析了 3 年无复发生存率和 5 年无复发生存率（5-RFS）。采用多变量 Cox 比例风险回归分析确定独立的危险因素。我们建立了一个列线图，并进行了 Harrell 的一致性指数、校准图、综合判别改善和决策曲线分析，以评估其判别和校准能力。
中位随访时间为 45 个月。多变量分析显示，肿瘤直径、病理亚型、术前癌胚抗原水平和术前细胞角蛋白 19 片段 21-1 水平是 RFS 的独立预后因素（P<0.05）。这些危险因素被用于构建一个列线图，以预测这些患者术后的复发和转移。内部验证采用 bootstrap 方法。C 指数为 0.946（95%置信区间：0.923-0.970），表明该模型具有良好的预测性能。使用列线图和 X-tile 软件，将患者分为两组：高风险组（5-RFS 率为 0.10-0.90）和低风险组（5-RFS 率为 0.90-0.99）；两组间 RFS 率差异有统计学意义（χ2=86.705，P<0.001）。
与肿瘤-淋巴结-转移分期系统和其他预测模型相比，我们的列线图对 VATS 肺叶切除术后 1A 期肺腺癌患者的复发和转移具有更好的预测能力。该列线图有助于提供个体化的治疗策略和随访时间。
