Development and Validation of Nomograms to Predict Overall Survival and Cancer-Specific Survival for Non-Small Cell Lung Cancer with Chest Wall Invasion: A Population-Based Study

Abstract

Abstract Background: Chest wall invasion is a relatively kind of infrequent direct tumor extension in non-small cell lung cancer (NSCLC) with a poor survival outcome. Risk factors that impact overall survival (OS) and cancer-specific survival (CSS) remain unclear. Therefore, we aimed to explore prognostic factors in NSCLC patients with chest wall invasion and construct predictive nomograms to predict both OS and CSS in NSCLC patients with chest wall invasion. Methods: We extracted a total of 2091 patients diagnosed with primary NSCLC with chest wall invasion between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. The total patients were divided into two groups randomly, the training cohort (1463 patients) and the validation cohort (628 patients). Univariate and multivariate Cox regression analyses were applied to distinguish the independent prognostic factors. Two prognostic nomograms for OS and CSS were established based on the training cohort and were evaluated in both cohorts. The concordance index (C-index), receiver operating characteristic curves (ROC), calibration curves, and decision curve analysis (DCA) curves were applied to assess the performance of these two nomograms. Results: After multivariate Cox analysis, age, sex, histology, grade, N stage, M stage, surgery, and chemotherapy were identified as independent prognostic factors for OS, meanwhile, age, histology, grade, N stage, M stage, surgery, and chemotherapy for CSS. The C-index of the nomogram for OS in the training and validation cohorts was 0.711 and 0.716, respectively. The C-index of the nomogram for CSS in the training and validation cohorts was 0.721 and 0.726, respectively. The ROC curves, calibration curves, DCA curves, and K-M survival curves also exhibited good predictive performance in the training and validation cohorts of these two prognostic nomograms. Conclusion: Two nomograms provide a useful and reliable tool to predict both OS and CSS in NSCLC patients with chest wall invasion. These nomograms can provide strong references to facilitate clinic decisions.