Wang Yuyan, Zheng Qiwen, Jia Bo, An Tongtong, Zhao Jun, Wu Meina, Zhuo Minglei, Li Jianjie, Zhong Jia, Chen Hanxiao, Yang Xue, Chi Yujia, Dong Zhi, Sepesi Boris, Zhang Jianjun, Gay Carl M, Wang Ziping
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Front Oncol. 2020 Apr 24;10:626. doi: 10.3389/fonc.2020.00626. eCollection 2020.
We aimed to assess the survival benefit of surgery for patients with stage IA-IIB small cell lung cancer (SCLC) and construct a nomogram for predicting overall survival (OS). Patients who had been diagnosed with stage IA-IIB SCLC between 2004 and 2014 and who had received active treatment were selected from the Surveillance, Epidemiology, and End Results database. The primary endpoint was OS. Cox proportional hazards models and propensity score (PS) analyses were used to compare the associations between surgery and OS. The probability of 1- and 3-year OS was predicted using a nomogram. We reviewed 2,246 patients. The median OS of the surgery and non-surgery groups was 35 months and 19 months, respectively. Multivariable Cox proportional hazards models showed a survival benefit in the surgery group (hazards ratio [HR], 0.642; 95% confidence interval [CI], 0.557-0.740; < 0.001). To balance the between-group measurable confounders, the impact of surgery on OS was assessed using PS matching. After PS matching, OS analysis still favored surgical resection. The PS-stratification, PS-weighting, and PS-adjustment models showed similar results to demonstrate a statistically significant benefit for surgery. Further, the nomogram was well calibrated and had good discriminative ability (Harrell's -index = 0.645). Our analysis suggests that surgery is a viable option for patients with early-stage SCLC. Our nomogram is a viable tool for quantifying treatment trade-off assumptions and may assist clinicians in decision-making. Future work is needed to validate our results and improve our tools.
我们旨在评估手术对IA-IIB期小细胞肺癌（SCLC）患者的生存获益，并构建一个预测总生存期（OS）的列线图。从监测、流行病学和最终结果数据库中选取2004年至2014年间被诊断为IA-IIB期SCLC且接受过积极治疗的患者。主要终点为OS。采用Cox比例风险模型和倾向评分（PS）分析来比较手术与OS之间的关联。使用列线图预测1年和3年OS的概率。我们回顾了2246例患者。手术组和非手术组的中位OS分别为35个月和19个月。多变量Cox比例风险模型显示手术组有生存获益（风险比[HR]，0.642；95%置信区间[CI]，0.557 - 0.740；P < 0.001）。为平衡组间可测量的混杂因素，采用PS匹配评估手术对OS的影响。PS匹配后，OS分析仍支持手术切除。PS分层、PS加权和PS调整模型显示了相似的结果，表明手术具有统计学显著获益。此外，列线图校准良好且具有良好的辨别能力（Harrell's C指数 = 0.645）。我们的分析表明，手术是早期SCLC患者的一个可行选择。我们的列线图是量化治疗权衡假设的一个可行工具，可能有助于临床医生进行决策。未来需要开展工作来验证我们的结果并改进我们的工具。
