Xu Zihan, Wang Li, Tu Li, Liu Yanyang, Xie Xiaoxiao, Tang Xiaojun, Luo Feng
Lung Cancer Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University Chengdu, Sichuan, China.
Laboratory of Experimental Oncology, West China Hospital of Sichuan University Chengdu, Sichuan, China.
Am J Cancer Res. 2020 Nov 1;10(11):3801-3814. eCollection 2020.
Sarcomatoid carcinoma (SC) is regarded as a rare malignant neoplasm associated with poor outcomes. This study aimed to explore the epidemiological characteristics and prognostic factors of SC, and establish a clinical predictive model. The Surveillance, Epidemiology, and End Results database was used for data inquiry of patients with SC. Relevant population materials were used for age-adjusted incidence, limited-duration prevalence and prognostic analyses, and also for nomogram construction and validation. A total of 17,917 cases of SC were identified. Among them, 12,276 (68.52%) were women and 14,265 (79.62%) were white. Most cases occurred in the female genital system, accounting for 41.10% of all SCs. The median age at diagnosis was 68 years. The incidence and prevalence of SC increased substantially over time. The age-adjusted incidence increased from 0.31/100,000 in 1973 to 1.26/100,000 by 2014, a 4.06-fold change. Among site groups, the incidence of SC in the female genital and the respiratory system increased most significantly ( < 0.001). As for stage and grade, the incidence increased the most in distant and high-grade SC, respectively ( < 0.001). Moreover, the survival duration varied significantly by site, histology, stage and grade ( < 0.001). The multivariable analyses showed that the year of diagnosis, age, sex, race, grade, stage, and site were all significant prognostic factors ( < 0.001). Among these, stage and primary tumor site were the most valuable indicators of outcomes. Furthermore, a nomogram comprising age, histology, grade, stage and site were established to predict the 3-/5-year survival probability. The concordance indexes of the nomogram were 0.745 (95% confidence interval [CI]: 0.737-0.753) and 0.743 (95% CI: 0.728-0.756) for the internal and external validations, respectively. The calibration plot demonstrated satisfactory consistency between the actual and predicted outcomes in both the internal and external validations. In conclusion, increasing incidence and prevalence of SC was observed in our study, suggesting that SC is more prevalent than previously reported. Clinicians should be familiar with the characteristics of these tumors. Furthermore, the established nomogram could accurately predict the 3-/5-year survival rate of patients with SC, which may be of value for patient counselling and risk stratification.
肉瘤样癌（SC）被认为是一种罕见的恶性肿瘤，预后较差。本研究旨在探讨SC的流行病学特征和预后因素，并建立临床预测模型。利用监测、流行病学和最终结果数据库对SC患者进行数据查询。使用相关人群资料进行年龄调整发病率、限期患病率和预后分析，以及列线图构建和验证。共识别出17917例SC病例。其中，12276例（68.52%）为女性，14265例（79.62%）为白人。大多数病例发生在女性生殖系统，占所有SC病例的41.10%。诊断时的中位年龄为68岁。SC的发病率和患病率随时间大幅上升。年龄调整发病率从1973年的0.31/10万增加到2014年的1.26/10万，增长了4.06倍。在部位组中，女性生殖系统和呼吸系统的SC发病率增长最为显著（<0.001）。至于分期和分级，远处转移和高级别SC的发病率分别增长最多（<0.001）。此外，生存时间因部位、组织学、分期和分级而有显著差异（<0.001）。多变量分析表明，诊断年份、年龄、性别、种族、分级、分期和部位都是显著的预后因素（<0.001）。其中，分期和原发肿瘤部位是预后最有价值的指标。此外，建立了一个包含年龄、组织学、分级、分期和部位的列线图来预测3/5年生存概率。列线图的一致性指数在内部验证和外部验证中分别为0.745（95%置信区间[CI]：0.737-0.753）和0.743（95%CI：0.728-0.756）。校准图显示内部和外部验证中实际结果与预测结果之间具有令人满意的一致性。总之，本研究观察到SC的发病率和患病率不断上升，表明SC比之前报道的更为普遍。临床医生应熟悉这些肿瘤的特征。此外，所建立的列线图可以准确预测SC患者的3/5年生存率，这可能对患者咨询和风险分层有价值。
