Early Non-small Cell Lung Cancer Resection Analysis Of Risk Factors For Recurrence And Establishment Of Predictive Models

Background and objective:Lung cancer is the leading cause of cancer deaths worldwide.Early stage(?-?)in non-small cell lung cancer(NSCLC)in patients with postoperative recurrence rates ranging from 20% to 50%.TNM staging system is the cornerstone for the prognosis of patients and the choice of postoperative treatment.However,patients in the same stage also have different recurrence and prognosis,which indicates that there areother factors affecting the prognosis of early NSCLC.At present,there are few reports on the prediction model of early postoperative recurrence of NSCLC.This study aims to explore the risk factors of early postoperative recurrence of NSCLC,and then build a prediction model based on these risk factors to predict the probability of early postoperative recurrence of NSCLC in a personalized way,screen the high-risk population,and guide postoperative follow-up and treatment.Methods:This study used a retrospective cohort study design to select 289 patients with early non-small cell lung cancer who underwent surgical resection in the First Affiliated Hospital of Nanchang University from January 2015 to June 2016.The follow-up date was January 2019.Including: basic information of the patient,initial symptoms,preoperative test results,surgical pathology data,postoperative chemotherapy,follow-up and other information.The patient's postoperative recurrence was determined by querying electronic medical records and telephone follow-up.Statistical analysis was performed using SPSS21.0 data software and easy-to-use statistical software(EmpowerStats).Survival curves were drawn by Kaplan-Meier method and the probability of recurrence was calculated.Log-rank test was used to compare the survival differences of each group,and the single-factor Cox proportional risk was applied.The model estimates the association between clinical pathological variables and RFS,and factors with a P value of <0.05 in the univariate analysis were included in the multivariate analysis.A multivariate Cox stepwise regression model(choose backwards,using the AIC information criteria)was used to determine independent prognostic factors.Based on the regression coefficient ? and other information of the independent prognostic factor in the Cox regression model,a nomogram of the recurrence-free survival rate of early NSCLC after surgery(drawn by the R package “ms”)was used,and the Bootstrap method(1000 re-sampling)was used for the column line.The graph is internally verified,and the prediction accuracy of the nomogram is evaluated by the Harrell's Concordance index(c-index),and the calibration curve of the nomogram is drawn.Results:1.This study included 289 patients with early stage NSCLC with a median follow-up of 36 months(3-48 months).There were 101 cases of recurrence and the probability of recurrence was 34.9%.The 1-year recurrence-free survival rate(RFS)was 89.59%,the 2-year RFS was 74.08%,and the 3-year RFS was 64.57%.First,univariate analysis showed that gender,age,pathological type,tumor size,T stage,N stage,total stage,CEA,Cyfra21-1 and other factors were significantly different from the risk of recurrence of early NSCLC(P<0.05).Then,we further included the first nine factors in the multivariate Cox regression model.The results showed that gender,age,histological type,T stage,N stage,CEA,Cyfra21-1 and other factors were independent risk factors of recurrence after NSCLC(P<0.05).Based on these risk factors,a nomogram plot was developed to predict recurrence-free survival in patients with early-stage NSCLC for 1,2,and 3 years.Finally,through the Bootstrap method for internal verification,we found that the prediction accuracy of the nomogram is higher than the traditional TNM staging(C-index: 0.699 vs.0.591).2.Stratified analysis showed that postoperative adjuvant chemotherapy reduced the risk of recurrence in patients with stage IIB by 60%(HR 0.4 95% CI 0.2-0.8,P < 0 05).However,it also showed a trend of benefit to?B and?A,but it did not reach statistical significance.There was no benefit to the recurrence period of stage ?A.Conclusion:1.This study clarified the independent risk factors of postoperative recurrence in patients with early stage non-small cell lung cancer by seven factors including gender,age,histological type,T stage,N stage,CEA,Cyfra21-1,and based on the above risk factors.A nomogram of predicting recurrence-free survival after early NSCLC.The nomogram can accurately predict the probability of recurrence of early NSCLC,and can guide clinicians to develop a reasonable follow-up strategy and select appropriate adjuvant treatment to improve the prognosis of patients,which has certain application value.2,Adjuvant chemotherapy can reduce the risk of recurrence ? B NSCLC patients,and should be routine adjuvant chemotherapy for stage IIB.Postoperative adjuvant chemotherapy has a tendency to reduce recurrence in patients with stage IIA and IB(not statistically significant)and no benefit for recurrence-free survival in stageIA.