Analysis Of Prognosis Factors In Small Cell Lung Cancer

Objectives The aim of this study is to retrospectively review the factors that may affect prognosis of SCLC patients and to establish a predictive model(Nomogram)for predicting the survival of patients with small cell lung cancer.Methods A total number of 265 patients who were diagnosed as SCLC and received treatment in Tangshan People’s Hospital from January 2012 to December 2014 were enrolled in this study.They all had complete medical history and follow-up data.The data was statistically analyzed by SPSS 22.0 software and Kaplan-Meier,Cox proportional hazards model were used in univariate and multivariate survival analysis respectively.According to the Cox regression coefficients,Nomogram was developed by R software and consistency index(C-index)and Calibration curve were applied in internal validation to verify the validity of Nomogram.Results The results of univariate analysis showed that factors as clinic stage,KPS score,neutrophils/lymphocytes ratio(NLR),thyroid transcription factor1(TTF-1)expression,tumor markers(CEA,NSE,CYFRA21-1),C-reactive protein(CRP),lactate dehydrogenase(LDH),blood sodium,pleural effusion,operation,chemotherapy cycles,thoracic radiation therapy and PCI treatment are closely related with the survival time of patients.However,age,gender,smoking habits are not related with the survival time.Multivariate analysis suggested that limited stage disease,KPS ≥ 80,thyroid transcription factor 1(TTF-1)positive expression,operation,chemotherapy cycles≥4,thoracic radiation therapy,prophylactic cranial irradiation were the independent protective prognostic factors of survival.But extensive stage disease,utrophils/lymphocytes ratio(NLR)≥4,elevated C-reactive protein(CRP),elevated lactate dehydrogenase(LDH)and hyponatremia were the independent hazard factors of survival.According to Nomogram based on the Cox regression database,the internal validation showed that the consistency index(C-index)was 0.80,the calibration curve was drawn and the slope was close to 45°.The internal validation showed that Nomogram is accurate in the prediction of small cell lung cancer survival.Conclusions 1 The clinic stage before the first treatment,KPS score,thyroid transcription factor-1(TTF-1)expression,neutrophils/lymphocytes ratio(NLR),C-reactive protein(CRP),lactate dehydrogenase(LDH)and blood sodium were the independent prognostic factors of survival for SCLC patients.2 Operation for patients at early stage(Ⅰ-Ⅱ),chemotherapy cycles≥4,thoracic radiation therapy and prophylactic cranial irradiation can extend survival time of patients,which were the independent prognostic factors of survival.3 The Nomogram based on Cox regression coefficient can be used to predict survival of SCLC patients in a direct and individualized way and to provide reference for clinical decision-making.