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Objective <p>To identify the prognostic factors for extensive-stage small cell lung cancer (ES-SCLC) patients after chemoradiotherapy and to develop an effective nomogram for predicting overall survival (OS).</p> Method <p>Data of ES-SCLC patients who received chemoradiotherapy from 2010 to 2020 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. For intergroup analysis, data were clustered into train and test sets at random (ratio: 7:3). Cox proportional hazards model and stepwise regression were used to identify independent risk factors for OS and to construct a prognostic nomogram. The nomogram’s performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA), and compared with the American Joint Committee on Cancer (AJCC) TNM (Tumor-Node-Metastasis) staging system. Risk stratification was performed using X-tile software. Kaplan-Meier survival curves were plotted to compare outcomes. An independent external validation cohort (<i>N</i> = 100) was used to further verify the model.</p> Results <p>1,336 ES-SCLC patients were included (train set: 935; test set: 401). Multivariate Cox regression analysis uncovered that being male, age over 74 years, liver metastasis, bilateral laterality, brain metastasis, bone metastasis, N3 stage, and tumor size between 28 and 80&#xa0;mm and over 80&#xa0;mm were independent risk factors (<i>P</i> &lt; 0.05) for ES-SCLC patients receiving chemoradiotherapy. In comparison with the TNM staging, the nomogram demonstrated superior predictive ability for 1-year, 3-year, and 5-year survival in both the train set (AUC: 0.69 vs. 0.53, 0.74 vs. 0.57, 0.79 vs. 0.62) and the test set (AUC: 0.67 vs. 0.55, 0.79 vs. 0.63, 0.82 vs. 0.70). Furthermore, it exhibited robust performance in the external validation cohort (1-, 3-, 5-year AUC: 0.75, 0.78, 0.76). Calibration curves indicated good agreement with the diagonal. DCA results demonstrated a positive net benefit. Patients with low risk (&lt; 204 points) had better survival outcomes than those with medium risk (204–229 points) and high risk (&gt; 229 points) (<i>P</i> &lt; 0.0001).</p> Conclusion <p>We constructed and validated a nomogram that effectively predicts survival in ES-SCLC patients after chemoradiotherapy, which could assist clinicians in devising more precise and individualized treatment strategies.</p>

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A nomogram predicting prognosis of extensive-stage small cell lung cancer patients receiving chemoradiotherapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月4日

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  • Hong Pan,
  • Guangpeng Chen,
  • Yong Dong,
  • Dezhi Li,
  • Da Li

摘要

Objective

To identify the prognostic factors for extensive-stage small cell lung cancer (ES-SCLC) patients after chemoradiotherapy and to develop an effective nomogram for predicting overall survival (OS).

Method

Data of ES-SCLC patients who received chemoradiotherapy from 2010 to 2020 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. For intergroup analysis, data were clustered into train and test sets at random (ratio: 7:3). Cox proportional hazards model and stepwise regression were used to identify independent risk factors for OS and to construct a prognostic nomogram. The nomogram’s performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA), and compared with the American Joint Committee on Cancer (AJCC) TNM (Tumor-Node-Metastasis) staging system. Risk stratification was performed using X-tile software. Kaplan-Meier survival curves were plotted to compare outcomes. An independent external validation cohort (N = 100) was used to further verify the model.

Results

1,336 ES-SCLC patients were included (train set: 935; test set: 401). Multivariate Cox regression analysis uncovered that being male, age over 74 years, liver metastasis, bilateral laterality, brain metastasis, bone metastasis, N3 stage, and tumor size between 28 and 80 mm and over 80 mm were independent risk factors (P < 0.05) for ES-SCLC patients receiving chemoradiotherapy. In comparison with the TNM staging, the nomogram demonstrated superior predictive ability for 1-year, 3-year, and 5-year survival in both the train set (AUC: 0.69 vs. 0.53, 0.74 vs. 0.57, 0.79 vs. 0.62) and the test set (AUC: 0.67 vs. 0.55, 0.79 vs. 0.63, 0.82 vs. 0.70). Furthermore, it exhibited robust performance in the external validation cohort (1-, 3-, 5-year AUC: 0.75, 0.78, 0.76). Calibration curves indicated good agreement with the diagonal. DCA results demonstrated a positive net benefit. Patients with low risk (< 204 points) had better survival outcomes than those with medium risk (204–229 points) and high risk (> 229 points) (P < 0.0001).

Conclusion

We constructed and validated a nomogram that effectively predicts survival in ES-SCLC patients after chemoradiotherapy, which could assist clinicians in devising more precise and individualized treatment strategies.