Risk factors and a prognostic model for patients with borderline resectable locally advanced T3–4N0–1 non-small cell lung cancer: a population-based study

BACKGROUND: Non-small cell lung cancer (NSCLC) is a malignant disease with a significant morbidity rate. For patients diagnosed with borderline resectable locally advanced (T3–4 invasion and N0–1) NSCLC, the optimal treatment and prognosis are still under debate. This study aimed to develop a predictive nomogram that could assess the prognosis of these patients and optimize clinical decision-making. METHODS: Between 2010 to 2015, the survival, demographic and clinical characteristics of patients with borderline resectable locally advanced T3–4N0–1 NSCLC were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazard regression analyses were conducted to identify potential factors, which were further utilized to develop a dynamic nomogram for personalized prediction. Internal and external validation were conducted to verify the predictive accuracy of the nomogram. RESULTS: Totally, 5,054 eligible records were enrolled into the study cohort. The included patients were divided into a training cohort (n=3,538) and a validation cohort (n=1,516) in a 7:3 ratio. Nine independent prognostic factors (including age, gender, primary site, lymph node removal, differentiation grade, T stage, N stage, histology and adjuvant chemotherapy) were finally included into the nomogram. The developed nomogram exhibited favorable discriminative ability with the C-index =0.71. Moreover, the calibration curves demonstrated excellent agreement between predicted and observed outcomes in both the training and validation cohorts. Notably, subgroup analyses revealed that neoadjuvant chemotherapy was significantly associated with a better overall survival (OS) (P<0.05) in patients staged as T3–4N1. CONCLUSIONS: In this study, we developed and validated a prognostic model to assist in clinical decision-making for patients with borderline resectable locally advanced T3–4N0–1 NSCLC. Our findings suggested that patients with T3–4N1 stage disease may derive significant benefits from neoadjuvant chemotherapy.