Predicting survival following surgical resection of lung cancer using clinical and pathological variables: The development and validation of the LNC-PATH score

Haval Balata*, Philip Foden, Tim Edwards, Anshuman Chaturvedi, Mohamed Elshafi, Alexander Tempowski, Benjamin Teng, Paul Whittemore, Kevin G. Blyth, Andrew Kidd, Deborah Ellames, Louise Ann Flint, Jonathan Robson, Elaine Teh, Robin Jones, Timothy Batchelor, Philip Crosbie, Richard Booton, Matthew Evison

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)


Introduction: The aim of this study was to develop and validate a simple prognostic scoring system using readily available clinical and pathological variables that could stratify patients according to the risk of death following lung cancer resection. We hypothesized that by using additional pathological variables not accounted for by pathological stage alone coupled with markers of overall fitness a new prognostic tool could be developed.

Methods: Multivariable logistic regression analysis of pathological and other clinical variables from patients undergoing surgical resection of non-small cell lung cancer (NSCLC) were used to determine factors independently associated with 2-year overall survival and so derive the scoring system. The model was then validated in an external multi-centre dataset.

Results: Using multivariable logistic regression on a large dataset (n = 1,421) the ‘LNC-PATH’ (Lymphovascular invasion, N-stage, adjuvant Chemotherapy, Performance status, Age, T-stage, Histology) prognostic score was devised and then validated using an external dataset (n = 402). This can be used to risk stratify patients into low, moderate and high-risk groups with a statistically significant difference between the three groups in their survival distributions. 83.8% of patients in the low-risk group survived two years after surgery compared to 55.6% in the moderate-risk group and 26.2% in the high-risk group. The score was shown to perform moderately well with an Area Under the Receiver Operating Characteristic curve (AUROC) value of 0.76 (95% CI: 0.73–0.79) and 0.70 (95% CI: 0.64–0.76) in the derivation and validation cohorts respectively.

Discussion: The LNC-PATH score predicts 2-year overall survival after surgery for NSCLC. This may allow the development of risk stratified follow-up protocols in survivorship clinics which could be the subject of future prospective studies.

Original languageEnglish
Pages (from-to)29-34
Number of pages6
JournalLung Cancer
Early online date31 Aug 2018
Publication statusPublished - 1 Nov 2018


  • Lung cancer
  • Non-small cell lung cancer (NSCLC)
  • Prognostic score
  • Survival
  • Thoracic surgery


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