Prognosis of surgery and nomogram for patients with IIIA lung squamous cell carcinoma: a propensity score matched SEER database analysis.

Background: Lung squamous cell carcinoma (LSCC) is a prevalent subtype of non-small cell lung cancer (NSCLC). While there have been some prognostic models for LSCC, models specifically addressing stage IIIA LSCC are still limited. The aim of this study is to develop a nomogram to predict the overall survival (OS) of patients with stage IIIA LSCC. Methods: Patients diagnosed with LSCC between 2,010 and 2,015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database, and their basic clinical characteristics were analyzed. A 1:1 propensity score matching (PSM) analysis was performed to balance the baseline characteristics of the patients. The OS of patients was evaluated using Kaplan-Meier analysis and compared with the log-rank test. Clinical prognostic factors related to OS were analyzed using univariate and multivariate Cox regressions, and a visual nomogram model for predicting patient prognosis was developed and validated. Results: This study included 4,268 patients with stage IIIA LSCC, comprising 1,157 cases in the cancer-directed surgery (CDS) group and 3,111 cases in the no-cancer-directed surgery (no-CDS) group. After PSM, 1,095 patients in the CDS group were matched with 1,095 patients in the no-CDS group. Kaplan-Meier survival analysis revealed the significant beneficial effect of surgery on OS in both the original and matched cohorts. Multivariate Cox analysis indicated that sex, age, marital status, surgery, and chemotherapy were independent prognostic factors for stage IIIA LSCC. Additionally, the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) curve demonstrated strong predictive performance in both the training and validation cohorts of the prognostic nomogram. Conclusions: Through univariate and multivariate Cox regression analyses, sex, age, marital status, surgery, and chemotherapy were identified as independent prognostic risk factors for OS in patients with stage IIIA LSCC. A nomogram was successfully developed to assist clinicians in making more informed treatment decisions.