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

Abstract

Introduction Molecular markers are important variables in the selection of treatment for cancer patients and highly associated with their survival. Therefore, a nomogram that can predict survival probability by incorporating epidermal growth factor receptor mutation status and treatments for patients with advanced adenocarcinoma would be highly valuable. The aim of the study is to develop and validate a novel nomogram, incorporating epidermal growth factor receptor mutation status and treatments, for predicting 1-year and 2-year survival probability of patients with advanced adenocarcinoma. Material and methods Data on 13,043 patients between June 1, 2011, and December 31, 2014 were collected. Seventy percent of them were randomly assigned to the training cohort for nomogram development, and the remaining 30% assigned to the validation cohort. The most important factors for constructing the nomogram were identified using multivariable Cox regression analysis. The discriminative ability and calibration of the nomograms were tested using C-statistics, calibration plots, and Kaplan-Meier curves. Results In the training cohort, 1-year and 2-year OS were 52.8% and 28.5% in EGFR(-) patients, and 73.9% and 44.1% in EGFR(+) patients, respectively. In EGFR(+) group, factors selected were age, gender, congestive heart failure, renal disease, number of lymph node examined, tumor stage, surgical intervention, radiotherapy, first-line chemotherapy, ECOG performance status, malignant pleural effusion, and smoking. In EGFR(-) group, factors selected were age, gender, myocardial infarction, cerebrovascular disease, chronic pulmonary disease, number of lymph node examined, tumor stage, surgical intervention, radiotherapy, ECOG performance status, malignant pleural effusion, and a history of smoking. Two nomograms show good accuracy in predicting OS, with a concordance index of 0.83 in EGFR(+) and of 0.88 in EGFR(-). Conclusions The survival prediction models can be used to make individualized predictions with different EGFR mutation status and a useful tool for selecting regimens for treating advanced adenocarcinoma.

Factors associated with overall survival in patients with non-squamous NSCLC in New Zealand: A comparative analysis by EGFR gene mutation status

“…Our nding of age at diagnosis, smoking status and performance status being signi cantly associated with survival in both EGFR mutation groups was consistent with that of a Taiwanese study of overall survival of advanced NSCLC patients 21 . However, in the Taiwanese study, being female was associated with better survival in both EGFR mutation groups.…”

“…Signi cant predictors commonly reported were histological type, stage of tumour, age, smoking status and performance status of patients 15−20 . Some studies integrated treatment information 18,21 , and some included radiological (such as CT image features) 16 and haematological (such as white blood cell count, haemoglobin level) 15,16 information.…”

“…Although the disease outcome may signi cantly be different depending on the EGFR mutation status, there has been limited research that investigated the overall survival of advanced NSCLC patients with a focus on the EGFR mutation status 20−22 . To our knowledge, only one Taiwanese study presented separate nomograms for predicting 1-year and 2-year overall survival in EGFR mutation-positive and -negative patients 21 . These models indicated signi cant differences in 1-year and 2-year overall survival in the two groups, with most other predictors having similar effects.…”

Prognostic impact of pleural effusion in patients with malignancy: A systematic review and meta‐analysis

“…The systematic review yielded 12,189 references from five electronic databases. Eventually, we identified 47 studies with a total of 146,117 patients that met our inclusion criteria 7‐13,15,19‐57 . The numbers of studies comparing the OS and PFS differences between patients with pleural effusion and patients without pleural effusion were 39 and nine, respectively.…”

“…Eventually, we identified 47 studies with a total of 146,117 patients that met our inclusion criteria. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 15 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 The numbers of studies comparing the OS and PFS differences between patients with pleural effusion and patients without pleural effusion were 39 and nine, respectively. Seven studies evaluated the prognostic value of massive pleural effusion and minimal pleural effusion.…”