Thus we attempted to build a
Thus, we attempted to build a prognostic model that combined STAS, VPI, VI and HS. Nomograms [18,19] have been validated as reliable tools to predict recurrence or survival and were used statistical prognostic models to generate the predictive probability of 5-year RFS and OS in this Calcipotriol study. Our nomogram consisted of four factors: STAS, VPI, VI and HS that were pathologically significant factors in the multivariate analysis of our study. The effects of several separate pathologic features were integrated into the nomogram to provide an individualized risk assessment for 5-year RFS and OS of each patient. Based on previous findings [2,, , , ,, , , ,, , , , ], STAS may be viewed as a new type of invasive tumor behavior for lung adenocarcinoma, and its incorporation into the novel prognostic model can contribute to improvements in prognostic stratification. Consider a patient with resected lung invasive adenocarcinoma ≤4 cm whose histological subtype is papillary pattern. The pathologic features of the tumor show the presence of STAS, VPI and VI. This patient`s nomogram calculated that the 5-year risk of recurrence is 55% (Fig. 3A; nomogram calculations are as follows: STAS = Presence, which corresponds to 100 points; VPI = Presence, which corresponds to 77 points; VI = Presence, which corresponds to 73 points; HS = papillary, which corresponds to 28 points; this equals 278 total points, corresponding to a 5-year RFS of 45%, recurrence of 55%). Similarly, the patient`s nomogram calculated that the 5-year risk of mortality is 52% (Fig. 3B; nomogram calculations are as follows: STAS = Presence, which corresponds to 67 points; VPI = Presence, which corresponds to 59 points; VI = Presence, which corresponds to 56 points; HS = papillary, which corresponds to 68 points; this equals 250 total points, corresponding to a 5-year OS of 48%, mortality of 52%). Therefore at 5 years, the patient has a 55% risk of recurrence, calculated by a nomogram that can identify a recurrence 81.22% of the time, the patient has a 52% risk of mortality, calculated by a nomogram that can identify a mortality 85.39% of the time. Discrimination is the ability to distinguish patients who experience recurrence and mortality from those who do not . The C-index of the nomogram for predicting the 5-year RFS was 0.8122 in the study cohort and 0.7928 the validation cohort. Similarly, the C-index of the nomogram for predicting the 5-year OS was 0.8539 in the study cohort and 0.8249 in the validation cohort. This showed that the nomogram can discern a patient with the event from a patient without the event approximately 80% of the RFS time and approximately 84% of the OS time. Thus, the prognostic model that included STAS, VPI, VI and HS could significantly predict the 5-year RFS and OS (Fig. 4). In both the study cohort and validation cohort, the calibration curves of the nomograms showed a good correlation between the nomogram-estimated risk and the actual observed risk in the 5-year RFS and OS. Furthermore, a substantially worse nomogram performance in external cohort does not necessarily render the nomogram invalid . Although the calibration curves for the predictive probability did not show a better correlation between the nomogram-estimated prediction and the actual observed result in the validation cohort, we still considered that the performance metrics were acceptable. Thus, Retrovirus would be appropriate to recommend the nomogram for use. In other words, the nomogram of the prognostic model was almost accurate for predicting the 5-year RFS and OS. It is controversial whether STAS can be considered to be associated with one type of tumor invasion or a reproducible artifact secondary to mechanical forces [3,15,16]. A multicenter prospective study showed that loose tissue fragments could be caused by mechanical forces during specimen handling, which was recognized as “STAKS [3,15]. Thus, it is important to accurately distinguish STAS from STAKS. There were no disagreements among the observers regarding the assessment of STAS in our study.