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Xi Chen



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    Lunch & Poster Display session (ID 58)

    • Event: ELCC 2019
    • Type: Poster Display session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1
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      60P - Nomogram for patients with stage I small cell lung cancer: A competing risk analysis (ID 277)

      12:30 - 13:00  |  Author(s): Xi Chen

      • Abstract
      • Slides

      Background

      Small-cell lung cancer (SCLC), accounting for about 15% of all lung cancers, is a subtype of lung cancer with poor prognosis. It has a 5-year survival rate of 7% and kills an estimated 250,000 people worldwide annually. Although many studies have estimated the prognosis of SCLC, most of them were conducted without considering competing risks. This study aimed to evaluate the probability of cause-specific death for patients with stage I small cell lung cancer (SCLC) with a competing risk analysis.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      We identified patients with stage I SCLC between 2004 and 2010 in the Surveillance Epidemiology, and End Results (SEER) database. We calculated the cumulative incidence function (CIF) for all the SCLC patients, and the differences in CIF between subgroups were estimated by Gray’s test. Proportional subdistribution hazard model was constructed to predict cancer-specific death for patients with stage I SCLC. We also built a competing risk nomogram based on Fine and Gray’s model to predict the 3-year, the 5-year prognosis of SCLC patients. We evaluated the model performance by the c-index and calibration plot using a bootstrap cross-validation method with 200 resamples. All statistical analyses and visualization were performed on R statistical software version 3.4.4 (Institute for Statistics and Mathematics, Vienna, Austria). Statistical significance was set as a 2-sided p < 0.05.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      We identified 864 stage I SCLC patients. The 5-year cumulative incidence of cause-specific death for stage I SCLC was 56.2% and 13.7% for other causes of death. Predictive factors for the prognosis of stage I SCLC included age, surgery, chemotherapy, and radiotherapy (Table). Fine and Gray competing risk regression model indicated that age at diagnosis, surgery treatment, and radiotherapy could be independent predictive factors of SCLC cause-specific death. Those who were diagnosed with SCLC at an older age were more like to die of lung cancer, with a subdistribution hazard ratios (sdHR) of 1.02 (95% CI, 1.012-1.03). Patients without treatment were at an elevated risk of SCLC cause-specific death except for chemotherapy, with an sdHR of 2.85 (95% CI, 2.29-3.54) and 1.89 (95% CI, 1.53-2.33) for patients without surgery and radiotherapy, respectively. No statistical significance was detected between chemotherapy and SCLC cause-specific death. The competing risk nomogram based on the Fine and Gray’s model was established to predict the 3-year and 5-year cause-specific death. The c-index for SCLC cause-specific mortality model was 0.66, and the calibration curves suggested that the nomogram was well-calibrated.

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      In the study, we performed a competing risk analysis in patients with stage I SCLC based on the SEER database. We discovered independent predictive factors of death due to SCLC and built a nomogram to calculate the 3- and 5-year cause-specific mortality. The competing risk nomogram might be a convenient tool to evaluate crude mortalities of stage I SCLC, and help clinicians to choose appropriate treatment strategies.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      The authors.

      213f68309caaa4ccc14d5f99789640ad Funding

      National Key R&D Program of China (2016YFC0905500).

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.

      Five-year cumulative incidences of death among patients with stage I SCLC

      CharacteristicsN (%)Event (%)Cause-specific death
      Death from other causes
      5 year (%) (95% CI)p5 year (%) (95% CI)p
      Total86468056.2 (52.9-59.5)13.7 (11.5-16.1)
      Age (years)<0.0010.127
      <65257 (29.7)178 (26.2)48.5 (42.2-54.4)12.5 (8.8-16.9)
      65+607 (70.3)502 (42.9)59.5 (55.5-63.3)14.2 (11.6-17.1)
      Sex0.2030.373
      Male407 (47.1)332 (52.9)59.2 (54.2-63.8)15.4 (12.0-19.1)
      Female457 (52.9)348 (40.8)53.6 (48.9-58.1)12.3 (9.5-15.5)
      Race0.0960.096
      White772 (89.4)609 (89.6)55.8 (52.2-59.2)14.4 (12.0-17.0)
      Black68 (7.9)49 (7.2)58.2 (45.3-69.0)6.0 (1.9-13.5)
      Others/Unknown24 (2.8)22 (3.2)65.2 (41.0-81.5)13.0 (3.0-30.6)
      Surgery< 0.0010.548
      Yes305 (35.3)187 (27.5)39.2 (33.7-44.6)11.5 (8.2-15.4)
      No559 (64.7)493 (72.5)65.6 (61.5-69.3)14.9 (12.1-18.0)
      Chemotherapy< 0.0010.719
      Yes567 (65.6)433 (63.7)53.1 (48.9-57.1)13.1 (10.4-16.0)
      No297 (34.4)247 (36.3)62.3 (56.5-67.5)15.0 (11.1-19.3)
      Radiotherapy0.0040.035
      Yes399 (46.2)313 (46.0)52.2 (47.1-56.9)15.1 (11.8-18.8)
      No465 (53.8)367 (54.0)59.8 (55.1-64.1)12.6 (9.7-15.8)

      SCLC: Small cell lung cancer; CI: confidence interval

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