Development and Validation a Nomogram and Prognosis of Chemotherapy for Evaluation in Giant-cell Lung Carcinoma With Metastases: A Propensity Score Matching Analysis

Abstract Background and Objectives: Whether chemotherapy couldimprove prognosis for giant-celllung carcinoma with metastases remains controversial. The present study aimed to determine the significanceof chemotherapy in patients with metastases giant-cell Lung carcinoma, and to develop a nomogram to predict its outcomes.Methods:Data of 566 patients from the Surveillance, Epidemiology, and End Results(SEER) database were analyzed; 346 matched patients were divided into a chemotherapy group and non-chemotherapy group, respectively, using the propensity scorematching method. Univariate and multivariate analyses were performed to determine theprognostic factors of giant-celllung carcinoma, and subgroup analysis was performed according tothe site of metastases. While a visual nomogram wasestablished to judge the prognosis.Results: With the median follow-up of 20.5 months, The 3-yearsurvival rates were 20.2% in the chemotherapy set and 16.7% in the non-chemotherapy set (P=0.006).Chemotherapy did improve the Giant-cell Lung Carcinoma survival rates in patients with metastases(HR = 0.490, 95% CI = 0.358–0.669, P<0.001). In subgroup analysis, radiotherapy did not improved the Giant-cell Lung Carcinoma survival rates in patients with metastases(HR = 0.951, 95% CI = 0.690-1.311, P = 0.758, Table 2). Chemotherapy improved the CSS in patients with lung metastases (HR = 0.090, 95% CI = 0.017-0.470, P =0.004).In addition, chemotherapy improved the CSS in patients with brain metastases (HR = 0.117, 95% CI = 0.014-0.955, P =0.045). Compared with bone metastasis, liver metastasis and metastasis of more than 2 sites, the effect of chemotherapy is not obvious.Furthermore, our nomogram could predict the probability of surviving to the median survival time of the population with a c-index of 0.768.Conclusion:The benefit of chemotherapy in giant-celllung carcinoma with metastases patients was obviously different, andthe recommendation of chemotherapy for this population should be individualized. chemotherapy shouldbe considered for patients with only lungmetastasis or brain metastasis, but chemotherapy could be avoided in those with other site metastases or multiple metastases.We developed the first competing risk nomogram to predict the risk of GCLC patients, which performed well in the evaluation and might be helpful for individualized screening.