Nomogram model for the preoperative prediction of spread through air spaces in sub-centimeter non-small cell lung cancer.

Introduction: To construct and validate a nomogram risk prediction model based on clinical characteristics and radiological features to predict spread through air spaces (STAS) of stage IA sub-centimeter non-small cell lung cancer.

Methods: 112 patients who underwent surgical treatment in Nanjing Drum Tower Hospital with pathologically diagnosed stage IA sub-centimeter non-small cell lung cancer were retrospectively collected. The training cohort and the validation cohort were chosen in a 7:3 ratio. Based on the presence or absence of STAS in pathology results, they were divided into STAS positive and STAS negative groups. The independent risk predictors of STAS in clinical characteristics and radiological features were selected by univariate and multivariate logistic regression analysis and then used to construct a nomogram. The sensitivity and specificity were calculated based on the Youden index, area under the curve (AUC), calibration curves and decision curve analysis (DCA) were used to evaluate the performance of the model.

Results: The incidence of STAS in the training cohort was 17.9%. Univariate logistic regression analysis showed that male, anti-GAGE7 antibody positive and mean CT value were associated with the occurrence of STAS; multivariate logistic regression analysis showed that male (OR = 7.900, 95%CI: 1.502-41.545), anti-GAGE7 antibody positive (OR = 10.065, 95%CI: 1.256-80.659) and mean CT value (OR = 1.009, 95%CI: 1.004-1.014) were independent predictors for STAS. The nomogram based on the above factors achieved good predictive performance for STAS with AUC was 0.897 (sensitivity was 0.929, specificity was 0.781) in the training cohort and 0.860 in the validation cohort. The calibration curve and DCA validated the good performance of the model.

Conclusion: The nomogram model established in this study had good predictive performance for STAS status of sub-centimeter lung cancer, and provide reference significance for preoperative planning of patients.