Filosso Pier Luigi, Guerrera Francesco, Evangelista Andrea, Welter Stefan, Thomas Pascal, Casado Paula Moreno, Rendina Erino Angelo, Venuta Federico, Ampollini Luca, Brunelli Alessandro, Stella Franco, Nosotti Mario, Raveglia Federico, Larocca Valentina, Rena Ottavio, Margaritora Stefano, Ardissone Francesco, Travis William D, Sarkaria Inderpal, Sagan Dariusz
Department of Thoracic Surgery, University of Torino, Torino, Italy
Department of Thoracic Surgery, University of Torino, Torino, Italy.
Eur J Cardiothorac Surg. 2015 Sep;48(3):441-7; discussion 447. doi: 10.1093/ejcts/ezu495. Epub 2015 Jan 5.
Typical carcinoids (TCs) are uncommon, slow-growing neoplasms, usually with high 5-year survival rates. As these are rare tumours, their management is still based on small clinical observations and no international guidelines exist. Based on the European Society of Thoracic Surgeon Neuroendocrine Tumours Working Group (NET-WG) Database, we evaluated factors that may influence TCs mortality.
Using the NET-WG database, an analysis on TC survival was performed. Overall survival (OS) was calculated starting from the date of intervention. Predictors of OS were investigated using the Cox model with shared frailty (accounting for the within-centre correlation). Candidate predictors were: gender, age, smoking habit, tumour location, previous malignancy, Eastern Cooperative Oncology Group (ECOG) performance status (PS), pT, pN, TNM stage and tumour vascular invasion. The final model included predictors with P ≤ 0.15 after a backward selection. Missing data in the evaluated predictors were multiple-imputed and combined estimates were obtained from five imputed data sets.
For 58 of 1167 TC patients vital status was unavailable and analyses were therefore performed on 1109 patients from 17 institutions worldwide. During a median follow-up of 50 months, 87 patients died, with a 5-year OS rate of 93.7% (95% confidence interval: 91.7-95.3). Backward selection resulted in a prediction model for mortality containing age, gender, previous malignancies, peripheral tumour, TNM stage and ECOG PS. The final model showed a good discrimination ability with a C-statistic equal to 0.836 (bootstrap optimism-corrected 0.806).
We presented and validated a promising prognostic model for TC survival, showing good calibration and discrimination ability. Further analyses are needed and could be focused on an external validation of this model.
典型类癌（TCs）是罕见的、生长缓慢的肿瘤，通常5年生存率较高。由于这些是罕见肿瘤，其治疗仍基于小规模临床观察，且尚无国际指南。基于欧洲胸外科医师协会神经内分泌肿瘤工作组（NET-WG）数据库，我们评估了可能影响TCs死亡率的因素。
使用NET-WG数据库对TCs生存情况进行分析。从干预日期开始计算总生存期（OS）。使用具有共享脆弱性的Cox模型（考虑中心内相关性）研究OS的预测因素。候选预测因素包括：性别、年龄、吸烟习惯、肿瘤位置、既往恶性肿瘤、东部肿瘤协作组（ECOG）体能状态（PS）、pT、pN、TNM分期和肿瘤血管侵犯。最终模型包括经过向后选择后P≤0.15的预测因素。对评估的预测因素中的缺失数据进行多次插补，并从五个插补数据集中获得合并估计值。
1167例TC患者中有58例的生命状态不可用，因此对来自全球17个机构的1109例患者进行了分析。在中位随访50个月期间，87例患者死亡，5年OS率为93.7%（95%置信区间：91.7 - 95.3）。向后选择产生了一个包含年龄、性别、既往恶性肿瘤、周围肿瘤、TNM分期和ECOG PS的死亡率预测模型。最终模型显示出良好的区分能力，C统计量等于0.836（经自助法乐观校正后为0.806）。
我们提出并验证了一个有前景的TCs生存预后模型，显示出良好的校准和区分能力。需要进一步分析，可侧重于该模型的外部验证。
