A Prognostic Model to Predict Mortality among Non–Small-Cell Lung Cancer Patients in the U.S. Military Health System

Abstract

Introduction Accurate prognosis assessment after non-small cell lung cancer (NSCLC) diagnosis is an essential step for making effective clinical decisions. This study is aimed to develop a prediction model with routinely available variables to assess prognosis in patients with NSCLC in the U.S. Military Health System. Methods We used the linked database from the Department of Defense’s Central Cancer Registry (CCR) and the Military Health System Data Repository (MDR). The dataset was randomly and equally split into a training set to guide model development and a testing set to validate the model prediction. Stepwise Cox regression was used to identify predictors of survival. Model performance was assessed by calculating area under the receiver operating curves (AUC) and construction of calibration plots. A simple risk scoring system was developed to aid quick risk score calculation and risk estimation for NSCLC clinical management. Results The study subjects were 5,054 patients diagnosed with NSCLC between 1998 and 2007. Age, sex, tobacco use, tumor stage, histology, surgery, chemotherapy, peripheral vascular disease, cerebrovascular disease and diabetes mellitus were identified as significant predictors of survival. Calibration showed high agreement between predicted and observed event rates. The AUC reached 0.841, 0.849, 0.848, and 0.838 over one, two, three and five years, respectively. Conclusions This is the first NSCLC prognosis model for quick risk assessment within the MHS. After external validation, the model can be translated into clinical use both as a web-based tool and through mobile applications easily accessible to physicians, patients and researchers.

Decision support systems for incurable non-small cell lung cancer: a systematic review

“…Few DSS have been developed in patient populations with mixed treatment options, but have not been externally validated, such as the Daniele score [ 63 ], Lin score [ 64 ] and Zhang score [ 65 ]. Only the Blanchon model [ 66 ] has been validated in another population [ 67 ], thereby, reaching Reilly level 2.…”

Development and validation of nomograms for predicting survival probability of patients with advanced adenocarcinoma in different EGFR mutation status

“…These findings are in agreement with previous reports on risk factors for NSCLC. [9, 14, 27, 30–33] Nonsmoking history has been identified as a prognostic indicator in many studies. [34–36] Our results revealed that for patients with either EGFR mutation positive or wild-type, the association between smoking status and survival remains significant in the presence of strong predictors, such as treatment and ECOG performance scores.…”

Metformin use and its effect on survival in diabetic patients with advanced non-small cell lung cancer

“…The association between diabetes mellitus and survival in lung cancer patients is controversial [ 23 ] Whereas some studies suggest that patients with diabetes mellitus have worse prognoses due to comorbidities and disease complications that can be related to a reduced tolerance of treatment [ 24 , 25 ], other studies have demonstrated that diabetic patients exhibited increased survival compared with non-diabetics [ 7 , 26 , 27 ]. The contradictory results between different studies might be the consequence of the analyses of heterogeneous populations.…”