A predictive model for identifying candidates for adjuvant chemotherapy based on recurrence risk profile of resected, node-negative (N0) non-small cell lung cancer

Abstract

Background:The decision for administering adjuvant chemotherapy (AC) in completely resected nodenegative non-small cell lung cancer (NSCLC) is guided by likelihood of disease recurrence or death based on tumor, node, metastasis (TNM) stage. However, within each TNM stage are sub-groups of patients that are more or less likely to relapse than stage alone predicts. Methods: In this retrospective cohort study, prospective data from 394 consecutive patients who underwent complete resection of node-negative NSCLC without adjuvant therapies, between 2002 and 2019 was retrospectively analyzed. Independent tumor and host risk factors for recurrence were subjected to multivariate analysis to develop a predictive risk model distributing patients into low-risk or high-risk categories. Results: Recurrence risk was independently predicted by a neutrophil:lymphocyte ratio (NLR) of ≥3.5[hazard ratio (HR), 1.9; 95% confidence interval (CI), 1.1-3.5], visceral pleural invasion (HR, 2.2; 95% CI, 1.3-3.8), histopathology other than adenocarcinoma or squamous cell (HR, 2.6; 95% CI, 1.2-5.5) and tumor size >33 mm (HR, 3.9; 95% CI, 2.3-6.7). The specific combination of risk factors contributed to a score for a risk model which classified 9% of Stage I and 69% of Stage ≥II patients as high-risk. The predicted 5-year disease-free survival (DFS) for high-risk and low-risk patients as scored by the predictive model was 30% and 85%, respectively.Conclusions: Our readily reproducible, low-technology model, developed from individually validated tumor/host risk factors, identified sub-groups of resected node-negative NSCLC patients at significantly discordant risk of recurrence to their TNM stage category.

A potential biomarker based on clinical-radiomics nomogram for predicting survival and adjuvant chemotherapy benefit in resected node-negative, early-stage lung adenocarcinoma

“…A comprehensive analysis based on data from The National Cancer Database, observed a survival benefit associated with ACT in patients with tumors 3 cm or larger and high-risk clinicopathological factors (10). Krivitsky et al constructed a risk stratification model for negative-node NSCLC and assigned 9% of stage I patients at high-risk who could be potential candidates for ACT (11). More interestingly, series studies demonstrated the improved survival associated with ACT even in stage IA patients with high-risk histopathological factors (12,13).…”