Abstract
BACKGROUND: The increased use of computed tomography has brought a corresponding increase in the numbers of early-stage lung cancer patients receiving treatment. However, even for stage IA3 lung adenocarcinoma, many patients experience postoperative recurrence and metastasis. The existing TNM staging system for lung cancer does not take many clinical and pathological factors into consideration, resulting in the failure to detect and intervene as soon as possible in those with high recurrence risk. The purpose of this study was to explore the risk factors for postoperative recurrence-free survival (RFS) in patients with stage IA3 lung adenocarcinoma, and to construct and verify a nomogram model for predicting RFS in patients with the disease. METHODS: This study analyzed patients with stage IA3 lung adenocarcinoma who underwent surgical treatment. Univariate and multivariate analysis were used to analyze the independent risk factors for postoperative RFS and establish a nomogram model. Concordance index (C-index), receiver operating characteristic curve, clinical decision analysis, and calibration curve were used to evaluate the discrimination and calibration of the nomogram model. Data from two other institutions were used for external validation, and the nomogram scores were combined with X-tile software to screen high-risk groups of recurrence. RESULTS: The internal cohort included 235 eligible patients with stage IA3 lung adenocarcinoma from 7,235 lung cancer. Multivariate analysis showed smoking, solid nodules, mucinous lung adenocarcinoma, and micropapillary component ≥5% were independent risk factors for RFS. A nomogram model was constructed based on the above results and the bootstrap method was used for internal validation. The internal and external validation C-indexes of the nomogram were 0.822 (95% CI: 0.751-0.891) and 0.812, respectively, indicating the obvious prediction performance was good. The X-tile software combined with nomogram scores showed the low-risk group (5-RFS rate, 0.65-0.99) had better RFS than the high-risk group (5-RFS rate, 0.20-0.65) (P<0.0001). CONCLUSIONS: We constructed a nomogram model for predicting postoperative RFS in patients with stage IA3 lung adenocarcinoma which can individually evaluate the risk of postoperative recurrence, screen high-risk groups, and develop individualized follow-up and intervention strategies to improve the survival rate of the patients.