Development and validation of an inflammation-nutrition indices-based nomogram for predicting early recurrence in patients with stage IB lung adenocarcinoma

Abstract

To explore the inflammation-nutrition indices and related clinical factors affecting early recurrence in patients with stage IB LUAD. A retrospective analysis was conducted on clinical and pathological data of patients diagnosed with stage IB LUAD who underwent radical surgery in our hospital from January 2016 to January 2021. Using R software, patients were randomly divided into training (n = 140) and validation (n = 59) cohorts in a 7:3 ratio. Univariate and multivariate Cox regression analyses were performed to identify risk factors for RFS and construct a predictive model. The performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), concordance index (C-index), and calibration curve. Clinical utility of the model was assessed using decision curve analysis (DCA). Multivariate Cox regression analysis revealed that vascular invasion, visceral pleural invasion, predominant pattern, preoperative NLR > 2.33, preoperative PLR > 127.62, and preoperative PNI ≤ 48.3 were independent risk factors for RFS. The C-index of the nomogram model constructed based on these independent risk factors was 0.825 (95% CI: 0.762-0.881) in the training cohort and 0.772 (95% CI: 0.667-0.876) in the validation cohort. The ROC curves showed AUCs of 0.902, 0.881, and 0.877 for 1-year, 2-year, and 3-year RFS in the training cohort and AUCs of 0.782, 0.825, and 0.732 in the validation cohort respectively. Calibration curve and decision curve analysis indicated good clinical value of the model. The nomogram model based on inflammation-nutrition indices has predictive value for early recurrence in patients with stage IB LUAD.

Keywords: Early recurrence; Inflammation-nutrition indices; Nomogram; Stage IB lung adenocarcinoma.

Fig. 1

Kaplan-Meier survival curves for RFS, stratified by (a) NLR, (b) LMR, (c) PLR and (d) PNI in LUAD patients with stage IB.

Fig. 2

Inflammation-nutritional marker-based nomogram for predicting early recurrence of LUAD patients with stage IB.

Fig. 3

The receiver operating characteristic (ROC) curves for predicting RFS at 1-, 2- and 3-year obtained by using established nomogram in training and internal validation cohort. (a) AUC curves for 1-, 2- and 3-year RFS in training cohort. (b) AUC curves for 1-, 2- and 3-year RFS in internal validation cohort.

Fig. 4

The calibration curve of the nomogram 1-year RFS in training and internal validation cohort. (a and b) The calibration curve of the nomogram 2-year RFS in training and internal validation cohort. (c and d) The calibration curve of the nomogram 1-year RFS in training and internal validation cohort (e and f).

Fig. 5

Decision curves for RFS at 1-, 2- and 3-year obtanined by using established nomogram in traning and internal validation cohort. DCA curves for 1-year RFS in training and internal validation cohort. (a and b) DCA curves for 2-year RFS in training and internal validation cohort. (c and d) DCA curves for 3-year RFS in training and internal validation cohort (e and f).