Prognostic Nomogram for Overall Survival in Small Cell Lung Cancer Patients Treated with Chemotherapy: A SEER-Based Retrospective Cohort Study

Introduction Small cell lung cancer (SCLC) is known for its rapid clinical progression and poor prognosis. In this study, we sought to establish a prognostic nomogram among SCLC patients who received chemotherapy. Methods We obtained 4971 SCLC patients' clinical information from the Surveillance, Epidemiology, and End Results (SEER) database for the period between 2004 and 2015. Patients were divided into training and validation sets. Two nomograms were established based on limited stage (LS) and extensive stage (ES) SCLC patients to predict 1-, 2-, and 3-year overall survival (OS) incorporating superior parameters from multivariate Cox regression. Receiver-operating characteristic curves (ROCs) were applied to assess the discrimination ability of the nomogram while the calibration plots were applied to verify the model. Kaplan-Meier method was applied to find survival curves. Decision curve analysis (DCA) was applied to compare OS between the nomograms and 7th American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system. Results Four and six clinical parameters were identified as significant prognostic factors for LS-SCLC and ES-SCLC patient's OS, respectively. The ROC curves indicated satisfactory discrimination capacity of the nomogram, with 1-, 2-, and 3-year area under curve (AUC) values of 0.89, 0.81, and 0.79 in LS-SCLC patients and 0.71, 0.66, and 0.66 in ES-SCLC patients, respectively. Calibration curves indicated that the nomogram showed good agreement with actual observations in survival rate probability. The survival curves among the LS-SCLC and ES-SCLC cohorts were consistent with the high-risk group having a worse prognosis than the low-risk group. Moreover, ROC and DCA curves showed our nomograms had more benefits than the 7th AJCC-TNM staging system. Conclusions We established two nomograms that can present individual predictions of OS among LS-SCLC and ES-SCLC patients who received chemotherapy. These proposed nomograms may aid clinicians in treatment strategy and design of clinical trials.

Automated summary

Two nomograms were established to predict individual overall survival (OS) among limited stage (LS) and extensive stage (ES) small cell lung cancer (SCLC) patients who received chemotherapy. The nomograms showed good discrimination capacity and calibration with actual observations, and had more benefits in predicting OS than the 7th American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system. The proposed nomograms may assist clinicians in treatment strategy and design of clinical trials.