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. 2023 Mar 31;15(3):1142-1154.
doi: 10.21037/jtd-22-997. Epub 2023 Mar 6.

Identified optimal candidates for pulmonary resection in octogenarians with non-small cell lung cancer: a web-based predictive model

Yizhou Peng #  1   2   3 , Yang Wo #  1   2   3 , Pengcheng Liu #  1   2   3 , Chongze Yuan  1   2   3 , Zhigang Wu  1   2   3 , Yan Shang  1   2   3 , Hui Hong  1   2   3 , Yihua Sun  1   2   3
Affiliations

Identified optimal candidates for pulmonary resection in octogenarians with non-small cell lung cancer: a web-based predictive model

Yizhou Peng et al. J Thorac Dis. .

Abstract

Background: A survival benefit from pulmonary resection was observed in octogenarians with non-small cell lung cancer (NSCLC). Meanwhile, the identification of patients who can indeed benefit can be difficult. Therefore, we aimed to establish a web-based predictive model to identify optimal candidates for pulmonary resection.

Methods: Octogenarians with NSCLC in Surveillance, Epidemiology and End Results (SEER) database were enrolled and split into the surgery and non-surgery groups based on whether they received pulmonary resection. Propensity-score matching (PSM) was utilized to eliminate the imbalance. Independent prognostic factors were identified. Patients in the surgery group who lived longer than the median cancer-specific survival (CSS) time of the non-surgery group were assumed to benefit from the surgery. The surgery group was further divided into the beneficial group and the non-beneficial group based on the median CSS time of the non-surgery group. Among the surgery group, a nomogram was established through a logistic regression model.

Results: A total of 14,264 eligible patients were extracted, with 4,475 (31.37%) patients receiving pulmonary resection. Surgery was an independent favorable factor of prognosis after PSM (median CSS time: 58 vs. 14 months, P<0.001). A total of 750 (70.4%) patients lived longer than 14 months (beneficial group) in the surgery group. Factors including age, gender, race, histologic type, differentiation grade, and tumor-node-metastasis (TNM) stage were used to formulate the web-based nomogram. The precise discrimination and predictive capability of the model were validated through receiver operating characteristic curves, calibration plots, and decision curve analyses.

Conclusions: A web-based predicted model was constructed to distinguish specific patients who can indeed benefit from pulmonary resection among octogenarians with NSCLC.

Keywords: Non-small cell lung cancer (NSCLC); nomogram; octogenarians; web-based predictive model.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-997/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of the study identifying optimal candidates for primary tumor resection among non-small cell lung cancer patients, along with recording of the number of patients and the reasons for exclusion from investigation. NSCLC, non-small cell lung cancer; SEER, Surveillance, Epidemiology and End Results; TNM, tumor-node-metastasis; AJCC, American Joint Committee on Cancer.
Figure 2
Figure 2
Kaplan-Meier curves for OS (A,B) and CSS (C,D) of patients aged 80 before and after PSM. OS, overall survival; CSS, cancer specific survival; PSM, propensity-score matching.
Figure 3
Figure 3
Subgroup analysis using forest plots indicating the HR and 95% CI of each subgroup (HR <1 indicates surgery could improve survival of elderly NSCLC patients). CI, confidence interval; HR, hazard ratio; NSCLC, non-small cell lung cancer; TNM, tumor-node-metastasis.
Figure 4
Figure 4
A nomogram to identify the optimal candidates for pulmonary resection in octogenarians with NSCLC. NSCLC, non-small cell lung cancer.
Figure 5
Figure 5
Screenshot of web-based nomogram. NSCLC, non-small cell lung cancer.
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