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Updated: Apr 21, 2026
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Prognostic nomogram to predict survival after surgery for synchronous multiple lung cancers in multiple lobes
Tawee Tanvetyanon1, David J Finley, Thomas Fabian
1*H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; †Department of Surgery, Memoral Sloan Kettering Cancer Center, New York, NY; ‡Department of Surgery, Albany Medical Center, Albany, NY; §Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France; ║Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy; ¶Yedikule Hospital for Chest Disease and Thoracic Surgery, Istanbul, Turkey; **Department of Surgery, University of Alabama at Birmingham, Birmingham, AL; and ††Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
Introduction:
In the absence of metastatic disease, surgery for synchronous non-small-cell lung cancers involving multiple lobes can be curative. However, there currently exists no reliable prognostic instrument for this patient population after surgery. We undertook an analysis to examine the prognostic significance of adenocarcinoma histology and developed a prognostic nomogram.
Methods:
This study was a pooled analysis of six previously reported datasets. Patients without extra-thoracic metastasis who underwent surgical resection of synchronous lung cancers in multiple lobes were included. Those with small cell cancer, carcinoid tumor, or exclusively carcinoma in situ were excluded. A multivariable Cox proportional hazards regression model was fitted to identify independent survival predictors for nomogram development.
Results:
Data from 467 patients were analyzed. Adenocarcinoma was a sole histology in 253 patients (54.2%). Those with exclusively adenocarcinoma histology had a better median survival than their counterparts: 67.4 versus 36.2 months, (p < 0.001). Multivariable analysis incorporating histology, sex, age, maximal T-size, highest N-stage, and laterality demonstrated that having exclusively adenocarcinoma histology independently predicted an improved survival: hazard ratio 0.61 (95% confidence interval: 0.48, 0.78). Other favorable survival predictors were N0, T-size less than or equal to 3 cm, bilateral cancers, age less than 70 years, and women sex. The developed nomogram was well calibrated and demonstrated a moderate to good discrimination with a bootstrap-corrected Harrell C-statistic of 0.70.
Conclusion:
Several unique features among patients with resected synchronous multiple lung cancers, including the presence of exclusively adenocarcinoma histology, are of prognostic significance. A simple nomogram incorporating these factors can be utilized to predict patient survival with acceptable accuracy.
