The role of surgery for atypical bronchopulmonary carcinoid tumor: Development and validation of a model based on Surveillance, Epidemiology, and End Results (SEER) database
The role of surgery for atypical bronchopulmonary carcinoid tumor: Development and validation of a model based on Surveillance, Epidemiology, and End Results (SEER) database
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手术治疗非典型支气管肺类癌的作用：基于监测、流行病学和最终结果 (SEER) 数据库的模型的开发和验证
DOI：
10.1016/j.lungcan.2019.11.006
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发表时间：
2020-01-01
期刊：
影响因子：
5.3
通讯作者：
Du, Jiajun
中科院分区：
文献类型：
--
作者：
Chen, Xiaowei;Pang, Zhaofei;Du, Jiajun
目的：由于肺非典型类癌的罕见性和缺乏前瞻性临床试验，导致对其生物学、治疗信息和预后的认识有限。本研究分析了来自监测、流行病学和最终结果（SEER）数据库的AC患者，以更好地了解这种疾病的临床特征，并为临床实践建立预后诺模图。采用单因素考克斯回归分析方法，对507例经SEER数据库病理证实的AC患者的总生存期（OS）和肺癌特异性生存期（LCSS）分析。在507个观察值中，464个用于多变量考克斯比例风险模型，作为新诺模图的训练队列。基于训练队列构建新的列线图，并通过外部验证队列进行验证，以预测AC的3年、5年和10年OS。采用Harrell’s C指数、校正图和决策曲线分析（DCA）分别检验其准确性和临床实用性。考克斯回归分析显示，年龄、原发肿瘤大小、N分期、M分期、手术和区域淋巴结检查是显著的预后因素，并作为预测因素纳入诺模图。培训队列中3年、5年和10年OS的C指数分别为0.722、0.737和0.712。3年、5年和10年OS预测的内部和外部校准图非常一致。结论：AC患者行肺叶或节段切除术有更好的OS和LCSS。构建并验证了诺模图，以预测AC患者的OS，并提供准确和个性化的生存预测。
Objectives: The rarity of atypical carcinoid (AC) of lung and the lack of prospective clinical trials lead to limited knowledge of its biology, treatment information and prognosis. The current study analyzed AC patients from the Surveillance, Epidemiology, and End Results (SEER) database to better understand the clinical characteristics of this disease and build a prognostic nomogram for clinical practice.Materials and methods: A total of 507 AC patients with pathological confirmation from SEER database were performed with univariate Cox regression analyses for both overall survival (OS) and lung cancer specific survival (LCSS) analyses. Of the 507 observations, 464 were used in the multivariable Cox proportional hazards model as training cohort of new nomogram. A new nomogram was constructed based on the training cohort and validated by an external validation cohort to predict the 3-, 5- and 10-year OS of ACs. The accuracy and clinical practicability were separately tested by Harrell's C-indexes, calibration plots and decision curve analyses (DCA).Results: Lobectomy and segmental resection were found to be protective factors for AC patients. Age, primary tumor size, N stage, M stage, surgery and regional lymph nodes examination were shown as significant prognostic factors in Cox regression analyses and included in the nomogram as predictors. The C-index in the training cohort for 3-, 5-, and 10-year OS were 0.722, 0.737 and 0.712, respectively. The internal and external calibration plots for predictions of the 3-, 5-, and 10-year OS were in excellent agreement. An online webserver was built based on the proposed nomogram for convenient clinical use.Conclusion: AC patients with lobectomy or segmental resection tended to have better OS and LCSS. A nomogram was constructed and validated to predict the OS for AC patients and to provide accurate and individualized survival predictions.