Objectives: Sublobar resection has been shown to be feasible for non-small cell lung cancers less than 2 cm in size based on several prospective studies. However, the prognosis of clinical N0 patients who experience an N-stage upgrade after surgery (known as occult lymph node metastasis) may be worse. The ability of predict occult lymph node metastasis in patients eligible for sublobar resection remains a controversial issue.
Methods: Patients with non-small cell lung cancer ≤2 cm in diameter and containing a solid component who underwent surgical treatment at the Affiliated Hospital of Qingdao University were retrospectively enrolled, and 1:1 case matching was performed. The risk factors were identified through logistic regression analyses and theoretical criteria, followed by the development of a nomogram that was evaluated using 200 iterations of 10-fold cross-validation.
Results: After case matching, 130 pairs of patients were selected for modelling. According to the multivariable logistic regression analysis, the carcinoembryonic antigen level, consolidation tumour ratio, mean computed tomography number and tumour margin were included in the nomogram. The cross-validated average area under the receiver operating characteristic curve was found to be 0.86. Furthermore, calibration curve and decision curve analyses demonstrated the excellent predictive accuracy and clinical utility of the nomogram respectively.
Conclusions: By utilizing accessible characteristics, we developed a nomogram that predicts the probability of occult lymph node metastasis in patients with NSCLC ≤2 cm with a solid component. Risk stratification with this nomogram could aid in surgical method decision-making.
Keywords: NSCLC; lymphatic metastasis; nomogram; prediction.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.