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. 2022 Sep 30:12:1005668.
doi: 10.3389/fonc.2022.1005668. eCollection 2022.

Development and validation of a prognostic nomogram for bone metastasis from lung cancer: A large population-based study

Weihua Li  1   2 , Zixiang Guo  3 , Zehui Zou  1   2 , Momen Alswadeh  1   2 , Heng Wang  1   2 , Xuqiang Liu  1   2 , Xiaofeng Li  1   2
Affiliations

Development and validation of a prognostic nomogram for bone metastasis from lung cancer: A large population-based study

Weihua Li et al. Front Oncol. .

Abstract

Background: Bone is one of the most common metastatic sites of advanced lung cancer, and the median survival time is significantly shorter than that of patients without metastasis. This study aimed to identify prognostic factors associated with survival and construct a practical nomogram to predict overall survival (OS) in lung cancer patients with bone metastasis (BM).

Methods: We extracted the patients with BM from lung cancer between 2011 and 2015 from the Surveillance, Epidemiology, and End Result (SEER) database. Univariate and multivariate Cox regressions were performed to identify independent prognostic factors for OS. The variables screened by multivariate Cox regression analysis were used to construct the prognostic nomogram. The performance of the nomogram was assessed by receiver operating characteristic (ROC) curve, concordance index (C-index), and calibration curves, and decision curve analysis (DCA) was used to assess its clinical applicability.

Results: A total of 7861 patients were included in this study and were randomly divided into training (n=5505) and validation (n=2356) cohorts using R software in a ratio of 7:3. Cox regression analysis showed that age, sex, race, grade, tumor size, histological type, T stage, N stage, surgery, brain metastasis, liver metastasis, chemotherapy and radiotherapy were independent prognostic factors for OS. The C-index was 0.723 (95% CI: 0.697-0.749) in the training cohorts and 0.738 (95% CI: 0.698-0.778) in the validation cohorts. The AUC of both the training cohorts and the validation cohorts at 3-month (0.842 vs 0.859), 6-month (0.793 vs 0.814), and 1-year (0.776 vs 0.788) showed good predictive performance, and the calibration curves also demonstrated the reliability and stability of the model.

Conclusions: The nomogram associated with the prognosis of BM from lung cancer was a reliable and practical tool, which could provide risk assessment and clinical decision-making for individualized treatment of patients.

Keywords: SEER database; bone metastasis; lung cancer; nomogram; prognosis.

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Conflict of interest statement

The reviewer CY declared a shared parent affiliation with all authors to the handling editor at the time of review. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for selection of bone metastases from lung cancer.
Figure 2
Figure 2
OS nomogram for lung cancer with bone metastasis. SCC, squamous cell carcinoma; SCLC, small cell lung cancer; LC, large cell; NSCLC/NOS, non-small cell lung cancer/not otherwise specified.
Figure 3
Figure 3
Training cohort ROC curves (A) and validation cohort ROC curves (C) for predicting 3- month, 6-month, and 1-year OS. Kaplan-Meier survival curves for training (B) and validation cohorts (D).
See this image and copyright information in PMC

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