A Multicenter Study Exploring Prognostic And Influencing Factors In Patients With Non Small Cell Lung Cancer After Surgery Using Competing Risk Models

ObjectiveObjective to explore the prognosis and its influencing factors of patients with non-small cell lung cancer（NSCLC）who underwent surgery for the first time by using the competitive risk model,and draw a nomogram,so as to provide the basis for clinical evaluation of NSCLC prognosis and selection of personalized clinical treatment.MethodA retrospective cohort study was used to collect the baseline data and 3-year survival status information of NSCLC patients who underwent surgery for the first time in three hospitals in Nanchang from 2016 to 2019.To construct a competing risk model（FINE&Gray Model）for the prognosis of patients with NSCLC undergoing surgery,perform univariate and multivariate analysis,and draw a nomogram for the prognosis of NSCLC surgery.Result1.A total of 630 NSCLC patients were included in this study.220 patients（34.9%）developed disease deterioration（including tumor recurrence,metastasis,and death from other causes）,including 73 patients（11.5%）with tumor recurrence,90patients（14.2%）with distant metastasis,57 patients（9.0%）died from other causes,and 122 patients（19.3%）died from lung cancer.2.The results of multivariate analysis showed that BMI,T stage and N stage,and number of lymph nodes removed were statistically significant.the results of univariate analysis showed that patients’gender,drinking habits,tumor pathological type,number of lymph nodes removed during the operation,T stage,N stage,number of positive lymph nodes,albumin level,CEA in the overall survival and progression free survival time were statistically significant in the two groups(P_OS,P_PFS<0.05).BMI was statistically significant in overall survival(P_OS<0.05);FEV1/FVC was statistically significant in progression free survival analysis(P_PFS<0.05);The age of diagnosis,smoking habits,specific surgical procedures,primary tumor location,and respiratory comorbidities had no statistical significance in the progression free survival of postoperative patients(P_PFS>0.05).Multivariate analysis showed that BMI,T stage and N stage,the number of lymph nodes removed and the number of positive lymph nodes were important prognostic factors for NSCLC.ConclusionThe results of this study showed that gender,BMI,drinking habits,tumor pathological type,the number of lymph nodes removed during the operation,the number of positive lymph nodes,T stage,N stage,albumin level,carcinoembryonic antigen（CEA）,FEV1/FVC were the influencing factors of the prognosis of patients with NSCLC;BMI value,T stage and N stage,and the number of positive lymph nodes were independent factors affecting the survival status of patients after surgery.BMI value,T stage and N stage,and the number of lymph nodes removed were independent factors affecting the disease progression of patients after surgery.The competitive risk model can provide a new perspective for clinician data analysis,and the nomogram can provide a more intuitive basis for personalized treatment in the prognosis prediction of patients with NSCLC surgery.