Elsevier

Journal of Thoracic Oncology

Volume 10, Issue 12, December 2015, Pages 1694-1702
Journal of Thoracic Oncology

Original Article
A Prognostic Model to Predict Mortality among Non–Small-Cell Lung Cancer Patients in the U.S. Military Health System

https://doi.org/10.1097/JTO.0000000000000691Get rights and content
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Introduction

Accurate prognosis assessment after non–small-cell lung cancer (NSCLC) diagnosis is an essential step for making effective clinical decisions. This study is aimed to develop a prediction model with routinely available variables to assess prognosis in patients with NSCLC in the U.S. Military Health System.

Methods

We used the linked database from the Department of Defense's Central Cancer Registry and the Military Health System Data Repository. The data set was randomly and equally split into a training set to guide model development and a testing set to validate the model prediction. Stepwise Cox regression was used to identify predictors of survival. Model performance was assessed by calculating area under the receiver operating curves and construction of calibration plots. A simple risk scoring system was developed to aid quick risk score calculation and risk estimation for NSCLC clinical management.

Results

The study subjects were 5054 patients diagnosed with NSCLC between 1998 and 2007. Age, sex, tobacco use, tumor stage, histology, surgery, chemotherapy, peripheral vascular disease, cerebrovascular disease, and diabetes mellitus were identified as significant predictors of survival. Calibration showed high agreement between predicted and observed event rates. The area under the receiver operating curves reached 0.841, 0.849, 0.848, and 0.838 during 1, 2, 3, and 5 years, respectively.

Conclusions

This is the first NSCLC prognosis model for quick risk assessment within the Military Health System. After external validation, the model can be translated into clinical use both as a web-based tool and through mobile applications easily accessible to physicians, patients, and researchers.

Key Words

Model
Military health system
Mortality
Non-small-cell lung cancer
Risk prediction

Cited by (0)

This project was supported by John P. Murtha Cancer Center, Walter Reed National Military Medical Center through the Uniformed Services University of the Health Sciences under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine and by the intramural research program of the National Cancer Institute. The original data linkage was supported by the United States Military Cancer Institute and Division of Cancer Epidemiology and Genetics, National Cancer Institute.

Disclosure: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Departments of the Navy and Army, the Uniformed Services University of the Health Sciences, the Department of Defense, National Cancer Institute, or the U.S. Government. Nothing in the presentation implies any Federal/DoD endorsement. The authors declare no conflicts of interest or financial disclosures.