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

doi:10.1016/j.lungcan.2018.08.026

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

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

7 Citations (Scopus)

Abstract

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 language	English
Pages (from-to)	29-34
Number of pages	6
Journal	Lung Cancer
Volume	125
Early online date	31 Aug 2018
DOIs	https://doi.org/10.1016/j.lungcan.2018.08.026
Publication status	Published - 1 Nov 2018

Keywords

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

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Balata, H., Foden, P., Edwards, T., Chaturvedi, A., Elshafi, M., Tempowski, A., Teng, B., Whittemore, P., Blyth, K. G., Kidd, A., Ellames, D., Flint, L. A., Robson, J., Teh, E., Jones, R., Batchelor, T., Crosbie, P., Booton, R., & Evison, M. (2018). Predicting survival following surgical resection of lung cancer using clinical and pathological variables: The development and validation of the LNC-PATH score. Lung Cancer, 125, 29-34. https://doi.org/10.1016/j.lungcan.2018.08.026

@article{0a9e0b992b0d475289a428e8ac5ff421,

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

abstract = "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 {\textquoteleft}LNC-PATH{\textquoteright} (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.",

keywords = "Lung cancer, Non-small cell lung cancer (NSCLC), Prognostic score, Survival, Thoracic surgery",

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

year = "2018",

month = nov,

day = "1",

doi = "10.1016/j.lungcan.2018.08.026",

language = "English",

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pages = "29--34",

journal = "Lung Cancer",

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publisher = "Elsevier Science Ireland",

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Balata, H, Foden, P, Edwards, T, Chaturvedi, A, Elshafi, M, Tempowski, A, Teng, B, Whittemore, P, Blyth, KG, Kidd, A, Ellames, D, Flint, LA, Robson, J, Teh, E, Jones, R, Batchelor, T, Crosbie, P, Booton, R & Evison, M 2018, 'Predicting survival following surgical resection of lung cancer using clinical and pathological variables: The development and validation of the LNC-PATH score', Lung Cancer, vol. 125, pp. 29-34. https://doi.org/10.1016/j.lungcan.2018.08.026

TY - JOUR

T1 - Predicting survival following surgical resection of lung cancer using clinical and pathological variables

T2 - The development and validation of the LNC-PATH score

AU - Balata, Haval

AU - Foden, Philip

AU - Edwards, Tim

AU - Chaturvedi, Anshuman

AU - Elshafi, Mohamed

AU - Tempowski, Alexander

AU - Teng, Benjamin

AU - Whittemore, Paul

AU - Blyth, Kevin G.

AU - Kidd, Andrew

AU - Ellames, Deborah

AU - Flint, Louise Ann

AU - Robson, Jonathan

AU - Teh, Elaine

AU - Jones, Robin

AU - Batchelor, Timothy

AU - Crosbie, Philip

AU - Booton, Richard

AU - Evison, Matthew

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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.

AB - 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.

KW - Lung cancer

KW - Non-small cell lung cancer (NSCLC)

KW - Prognostic score

KW - Survival

KW - Thoracic surgery

UR - http://www.scopus.com/inward/record.url?scp=85053076680&partnerID=8YFLogxK

U2 - 10.1016/j.lungcan.2018.08.026

DO - 10.1016/j.lungcan.2018.08.026

M3 - Article (Academic Journal)

C2 - 30429034

AN - SCOPUS:85053076680

VL - 125

SP - 29

EP - 34

JO - Lung Cancer

JF - Lung Cancer

SN - 0169-5002

ER -

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

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