A Nomogram to predict overall survival based on the log odds of positive lymph nodes for patients with stage III non-small cell lung cancer

Abstract

Abstract This study aimed to compare the prognostic efficiency of N stage from the American Joint Committee on Cancer (AJCC) staging system, lymph nodes ratio (LNR) and log odds of positive lymph nodes (LODDS) in patients with stage III non-small cell lung cancer (NSCLC). A nomogram based on LODDS was developed and validated to predict overall survival (OS) of patients with stage III NSCLC. A total of 2896 stage III NSCLC patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 and divided into training and validation sets. The prognostic efficiency of N stage, LNR, and LODDS were compared using the Harrell concordance index (C-index), the Akaike information criterion (AIC), and area under the receiver operating characteristic (ROC) curve (AUC). A multivariate Cox analysis was performed to determine the independent prognostic factors, and constructed a nomogram based on LODDS. LODDS showed a slight advantage in predicting OS for NSCLC among three lymph node staging systems. In the training set, the C-index of the LODDS-based model was 0.645, the AIC was 18383.43. The AUCs were 0.708, 0.675 and 0.671 for predicting 1-year, 3-year and 5-year OS. The calibration plots showed the superior clinical applicability of the nomogram. These results were confirmed in the validation set. As an independent prognostic factor for stage III NSCLC, LODDS showed superior prognostic efficiency among the three lymph node staging systems. This LODDS-based nomogram demonstrated better performance than the AJCC tumor-node-metastasis (TNM) staging system in predicting OS for stage III NSCLC.