Pulmonary carcinosarcoma: analysis from the Surveillance, Epidemiology and End Results database
Pulmonary carcinosarcoma: analysis from the Surveillance, Epidemiology and End Results database
复制标题
肺癌肉瘤：来自监测、流行病学和最终结果数据库的分析。
DOI：
10.1093/icvts/ivz215
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发表时间：
2020-01-01
影响因子：
--
通讯作者：
Zhang，Peng
中科院分区：
文献类型：
--
作者：
Sun，Liangdong;Dai，Jie;Zhang，Peng
肺癌肉瘤（PCS）是一种罕见的肿瘤。本研究探讨了PCS的临床病理特征和生存结局。方法查询了1988-2014年PCS的监测、流行病学和最终结果（SEER）数据库。通过多变量考克斯回归评估总生存期（OS），并构建列线图预测PCS的3年OS。使用一致性指数和曲线下面积分析评估预后性能。在M0手术治疗的患者中，使用似然比检验进行相互作用评估。根据患者年龄进行亚组分析。PCSs的临床特征进一步与其他非小细胞肺癌（NSCLC）进行了比较。多因素分析确定了年龄[风险比（HR）1.03，95%可信区间（CI）1.01-1.04]、手术（HR 0.53，95%CI 0.36-0.77）和化疗（HR 0.51，95%CI 0.36-0.73）与OS显著相关。列线图的一致性指数为0.747，曲线下面积为0.803。与未接受肺切除术的患者相比（HR 5.14，95% CI 1.64-16.07），接受肺切除术的患者中年龄与OS之间的相关性更强（相互作用P= 0.04），并且与老年人（年龄≥ 70岁）中的肺叶切除术相比，其结局较差。与腺癌、鳞癌和大细胞癌相比，PCS患者更容易接受手术治疗，淋巴结转移率更低（均P < 0.05）。在老年患者中，输尿管切除术与较差的生存率相关。
OBJECTIVESPulmonary carcinosarcoma (PCS) is a rare neoplasm. This study explored the clinicopathological characteristics and survival outcomes of PCS.METHODSThe Surveillance, Epidemiology and End Results (SEER) database (1988–2014) was queried for PCS. Overall survival (OS) was evaluated by multivariable Cox regression and nomograms were constructed to predict 3-year OS for PCS. Prognostic performance was evaluated using concordance index and area under the curve analysis. In M0 surgically treated patients, interaction assessments were performed using likelihood ratio tests. Subgroup analysis was performed according to patient age. The clinical features of PCSs were further compared to other non-small-cell lung cancers (NSCLCs).RESULTSMultivariable analysis identified age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01–1.04], surgery (HR 0.53, 95% CI 0.36–0.77) and chemotherapy (HR 0.51, 95% CI 0.36–0.73) as significantly associated with OS. The nomogram had a concordance index of 0.747 and an area under the curve of 0.803. The association between age and OS was stronger in those receiving pneumonectomy (P= 0.04 for interactions) compared to those that did not (HR 5.14, 95% CI 1.64–16.07), and was associated with a poorer outcome compared to lobectomy amongst the elderly (age ≥ 70 years). Patients with PCS were more likely to receive surgical treatment and had lower lymphatic metastasis compared to adenocarcinoma, squamous cell carcinoma and large cell carcinoma (allP< 0.05).CONCLUSIONSPCS had unique clinical features compared to common types of NSCLCs in terms of lymphatic invasion and surgical treatment. Pneumonectomy was associated with poorer survival in elderly patients.