A prognostic nomogram for oligometastatic non-small cell lung cancer incorporating extent of primary tumor resection as a key predictor

Zixuan Fei; Yang Pan; Xuanhong Jin; Leilei Wu; Junnan Ru; Yan Zhang; Yuqi Lin; Jian Zeng; Feng Li

doi:10.21037/jtd-2025-1-2661

A prognostic nomogram for oligometastatic non-small cell lung cancer incorporating extent of primary tumor resection as a key predictor

J Thorac Dis. 2026 May 31;18(5):513. doi: 10.21037/jtd-2025-1-2661. Epub 2026 May 15.

Authors

Zixuan Fei^#^{1

2}, Yang Pan^#^{1

2}, Xuanhong Jin³, Leilei Wu¹, Junnan Ru¹, Yan Zhang^{1

2}, Yuqi Lin^{1

2}, Jian Zeng^{1

2}, Feng Li¹

Affiliations

¹ Department of Pulmonary Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
² Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China.
³ Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

^# Contributed equally.

Abstract

Background: The optimal extent of surgical resection for oligometastatic non-small cell lung cancer (NSCLC) remains controversial. This study aimed to evaluate the impact of lobectomy versus sublobar resection on survival and to develop a prognostic nomogram for this patient population.

Methods: This study retrospectively analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database [2010-2019] for patients with stage IV NSCLC who had a single metastatic site. We used propensity score matching (PSM) to balance covariates. The Kaplan-Meier method was employed to estimate survival, with comparisons made via the log-rank test. A prognostic nomogram was built using a Cox model and its performance was checked with area under the receiver operating characteristic (AUC) curves and calibration plots.

Results: Following PSM, undergoing surgery on the primary tumor was linked to better overall survival (OS) and cancer-specific survival (CSS). In the surgical group, lobectomy was associated with a significantly longer median OS (28 vs. 13 months, P<0.001) and CSS (32 vs. 14 months, P<0.001) compared to sublobar resection. In a multivariate model, both lobectomy and receiving systemic therapy before surgery were independently linked to better prognoses. The resulting nomogram demonstrated strong predictive ability, with 1-, 2-, and 3-year OS AUC values ranging from 0.74 to 0.75 in the training set and 0.72-0.73 in the validation set, showing good calibration.

Conclusions: In our large, population-based analysis, lobectomy showed a clear survival advantage over sublobar resection for individuals with oligometastatic NSCLC. Furthermore, our validated nomogram serves as a dependable instrument for estimating individual patient outcomes and guiding treatment choices.

Keywords: Nomogram; Surveillance, Epidemiology, and End Results (SEER); lobectomy; local consolidative therapy (LCT); oligometastatic non-small cell lung cancer (oligometastatic NSCLC).