Discussion
NSCLC, tumor, lung tumors, weight loss, Lung Cancer
TUMOR, METASTASIS, LUNG TUMORS, NSCLC, LUNG CANCER
According to previous studies and clinical practice guidelines, combining thermal ablation and chemotherapy has manifested some gratifying advancements, such as improving local control rates of lung tumors and prolonging the survival of advanced NSCLC patients [The data was obtained from a multi-center, randomized, controlled, phase III clinical trial. The centers involved are all tertiary A-level hospitals located in Shandong province, China, which provided excellent medical conditions to perform such trials. This guaranteed the data used to construct the prediction model was of good quality and representativeness.From the model, we found that clinical TNM stage, tumor size, and weight loss are the three significant factors of PFS after MWA and chemotherapy in advanced NSCLC. According to The Eighth Edition IASLC Lung Cancer Stage Classification, the main difference between stage IIIB and stage IV is whether there is distant metastasis [In the model, clinical N stage, histology, and tumor location are the three predictors with relatively lower predictive efficiency. The Clinical N stage is an acknowledged risk factor for NSCLC. According to the IASLC database, a higher clinical N stage can lead to a worse prognosis [To build and validate the model, we divided the original data into two sets based on the center’s location where patients were engaged and treated in the RCT. It ensured the external validation data set conformed to the requirement of regional validation and improved the reliability of the validation. As the C-index of 0.7–0.8 and Brier Score of 0–0.25 is considered acceptable [To our knowledge, this is the first prediction model as well as the first published nomogram and scoring system for predicting the progression-free survival of advanced NSCLC patients who received MWA and chemotherapy. However, our study still has several limitations. First, due to the deficiency of original data, we failed to incorporate some potential prognostic factors (e.g., tumor cell differentiation, EGFR mutation, ALK-EML4 fusion) in variable analysis. Second, as the sample size of the external validation is relatively small, more data sets are warranted to better validate the reproductivity of the nomogram. Third, as the median follow-up time was 13.1 months, we failed to build a model that could predict 3- and 5-year PFS.In conclusion, we found weight loss, histology, clinical TNM stage, clinical N category, tumor location, and tumor size were prognostic factors of progression after receiving MWA plus chemotherapy in advanced NSCLC patients. After building and validating, we published a nomogram that can predict 1-year PFS and a simplified scoring system for risk-group stratification. Hopefully, this model will assist physicians to predict the individualized PFS of their patients and decide whether to perform or terminate MWA and chemotherapy according to the expected benefits.