Development Of Nomograms For Predicting The Operative Mortality And Long-term Survival Of Patients Who Underwent Pneumonectomy For Lung Cancer

Background and PurposeAlthough many studies have reported that patients have undergone entire lung removal for lung cancer along with high operative mortality,the trends in the incidence and associated risk factors for operative death have not been explored in a national population-based study.In addition,a clinical decision-making nomogram for predicting postpneumonectomy mortality remains lacking.MethodsA total of 10,337 patients diagnosed with lung cancer who underwent pneumonectomy between 1998 and 2016 were retrieved from the Surveillance,Epidemiology,and End Results(SEER)cancer registry.Multivariate logistic regression analysis was used to identify risk factors for predicting operative mortality.Thereafter,these independent predictors were integrated into a nomogram,and bootstrap validation was applied to assess the discrimination and calibration.Additionally,decision curve analysis(DC A)was used to calculate the net benefit of this forecast model.ResultsThe overall postpneumonectomy mortality between 1998 and 2016 was 10.3%,including a 30-day mortality of 4.2%;however,there were statistically significant decreases in the operative death rates from 8.8%in 1998 to 6.7%in 2016(P=0.009).Higher operative mortality was associated with advanced patients(P<0.001),male sex(P<0.001),right-sided pneumonectomy(P<0.001),squamous cell carcinoma(SCC)(P=0.008),number of positive lymph nodes(npLNs)5 or greater(P=0.010),and distant metastasis(P<0.001).However,induction radiotherapy(RT)was a protective factor(P<0.001).The nomogram integrating all of the above independent predictors was well calibrated and had a relatively good discriminative ability,with a C-statistic of 0.687 and an area under the receiver operating characteristic(ROC)curve(AUC)of 0.682;moreover,DC A demonstrated that our model was clinically useful.ConclusionsIf pneumonectomy was considered inevitable,clinical decision-making based on this simple but efficient predictive nomogram could help minimize the risk of operative death and maximize the survival benefit.Background and PurposeAlthough pneumonectomy is a straightforward technical procedure,but high operative mortality and poor prognosis have undoubtedly influenced its clinical application.The objective of this study was to evaluate prognosis in patients underwent pneumonectomy for lung cancer by using a large,national database.And then quantifiable nomograms were built to predict cancer-specific survival(CSS)and overall survival(OS).MethodsA total of 9,276 patients underwent pneumonectomy for lung cancer between 1998 and 2016 extracted from the surveillance,epidemiology,and end results(SEER)database were enrolled into Kaplan-Meier survival analysis and Cox regression model to identify independent risk factor associated with CSS and OS.The above independent predictors were integrated to develop nomograms,and the c-index and calibration curves were used to assess the predictive performance of the nomograms.ResultsThe estimated 5-year CSS and OS rate in patients underwent pneumonectomy for lung cancer was 55.5%and 40.2%,respectively.At multivariable analysis,predictors for CSS and OS comprised age,sex,histology,grade,T stage,N stage,M stage,radiotherapy and marital status.Subsequently,independent risk factors were all selected into the nomograms to predict CSS and OS.The nomograms were well calibrated and had good discriminative ability,with c-index of 0.687 for operative death model,0.640 for CSS model,and 0.615 for OS model.ConclusionsStrengthening perioperative management and monitor for high-risk patients identified by our nomogram,pneumonectomy has yielded acceptable rates of CSS and OS.Background and PurposeTherapeutic options for patients with second lung tumor(SLT)after previous pneumonectomy for lung cancer are sparsely reported and controversial.This study aims to compare the short-and long-term outcomes of different treatment patterns in patient with resectable postpneumonectomy SLT.MethodsPatients received previous pneumonectomy and subsequently occurred resectable SLT were extracted from the Surveillance,Epidemiology,and End Results(SEER)database[1998-2016].Treatment related mortality was compared using the Pearson chi-square test.Univariate and multivariate Cox regression analyses were performed to identify the independent prognostic factors for cancer-specific survival(CSS)and overall survival(OS).ResultsNinety-nine patients met the selection criteria with 5-year CSS and OS rates of 60.8%and 53.7%,respectively:23 patients received no lung resection(nLR)and 76 patients received lung resection(LR).There was no statistically significant difference between nLR group and LR group in both treatment related mortality(0.0%vs.2.6%,P=0.432),CSS(58.3%vs.61.7%,P=0.633)and OS(55.3%vs.53.3%,P=0.635).Patients with subsequent adenocarcinoma(P=0.001)and smaller tumor size of SLT(P<0.001)were more likely to receive LR treatment.In the LR subgroup analysis,patients received sublobar resection(SLR)had better CSS[hazard ratio(HR):0.381,95%confidence interval(CI):0.176-0.827,P=0.030]and OS(HR:0.562,95%CI:0.287-1.100,P=0.051)than those received lobectomy.ConclusionsSLR or non-surgical resection is reasonable therapeutic option for patients with resectable SLT after previous pneumonectomy to achieve long-term survival,with acceptable treatment related mortality.