Predicting overall survival in patients with stage III non-small cell lung cancer undergoing perioperative chemoradiotherapy

For patients with locally advanced non-small cell lung cancer (NSCLC) who have undergone potentially curative surgery, adjuvant chemoradiotherapy clearly provides a survival benefit, whereas the role of neoadjuvant chemoradiotherapy remains controversial. This study aimed to develop and validate a prognostic nomogram for patients with stage III NSCLC receiving perioperative chemoradiotherapy. We included patients diagnosed with stage III NSCLC who underwent perioperative chemoradiotherapy and employed variables from multivariable Cox regression models to construct a nomogram predicting overall survival (OS) at 12, 36, and 60 months. To assess the accuracy and predictive performance of the nomogram, we utilized the concordance index (C-index) and calibration curves with smooth curve fitting, and decision curve analysis (DCA) was applied to evaluate clinical utility. A total of 8148 patients met the inclusion criteria, of which 5703 were randomly assigned to the training cohort and 2445 to the validation cohort. Nine variables were identified as significant through multivariable Cox proportional hazards regression. The areas under the curve (AUC) for the training cohort at 12, 36, and 60 months were 0.626, 0.614, and 0.615, respectively, while the validation cohort showed AUCs of 0.619, 0.61, and 0.6. Calibration plots indicated that the predicted survival rates at 12, 36, and 60 months were generally consistent across both cohorts. DCA further demonstrated that the nomogram could effectively evaluate patient treatment benefits and has clinical applicability. Overall, we developed a nomogram to provide individualized survival predictions for stage III NSCLC patients undergoing perioperative chemoradiotherapy.