The nomograms to predict early death among metastatic small- cell lung cancer patients: a retrospective study based on SEER database

Background: This study aims to discriminate risk factors associated with early death (died within 3 months) in metastatic small-cell lung cancer (SCLC) patients, and construct predictive nomograms to help physicians in guiding individual treatment. Methods: Surveillance, Epidemiology, and End Results (SEER) database was used to obtain records of deceased metastatic SCLC patients. The univariate and multivariate logistic regression methods were managed to identify risk factors for early death in overall patients and chemotherapy recipients. Predictive nomograms were developed and then validated by receiver operating characteristics curve (ROC) and calibration plots to verify its' precision. Results: A total of 13,229 patients were collected of which 5,832 of them encountered early death. The univariate and multivariate logistic regression analysis identified variables that were negatively associated with early death include sex, age, race, sequence, T stage, N stage, organ metastasis. Chemotherapy and radiotherapy implementation significantly decreased the odds of early death. For the chemotherapy recipients, white male patients with advanced age (over 80 years old), T4 stage, multiple organ metastasis, and without radiotherapy most likely died within 3 months. The area under the curve (AUC) of the nomograms for overall population and chemotherapy recipients' early death prediction was 0.839 and 0.653. Conclusions: Early death among metastatic SCLC patients was extremely common in clinical practice. The nomograms constructed were able to assist clinical physicians in discriminating high-risk SCLC patients for targeted intervention, and elderly white male patients diagnosed with advanced T stage and multiple organ metastasis might be exempted from systemic treatment to receive palliative care.