Lu Lili, Shang Yuru, Zechner Dietmar, Mullins Christina Susanne, Linnebacher Michael, Zhang Xianbin, Gong Peng
Department of General Surgery, Molecular Oncology, and Immunotherapy, Rostock University Medical Center, Rostock, Germany.
Department of Plastic Surgery, Southern University of Science and Technology Hospital, Shenzhen, China.
Front Psychiatry. 2021 Jun 11;12:638152. doi: 10.3389/fpsyt.2021.638152. eCollection 2021.
If the diagnosis of neuroendocrine neoplasm (NEN) increases the risk of patients to commit suicide has not been investigated so far. Identifying NEN patients at risk to commit suicide is important to increase their life quality and life expectancy. Cancer cases were extracted from the Surveillance, Epidemiology, and End Results program and were divided into the NEN and the non-NEN cohorts. Subsequently, the NEN patients were randomly split into a training data set and a validation data set. Analyzing the training data set, we developed a score for assessing the risk to commit suicide for patients with NEN. In addition, we validated the score using the validation data set and evaluated, if this score could also be applied to other cancer entities by using the test data set, a non-NEN cohort. The odds ratio (OR) of suicide between NEN and non-NEN patients was determined. Moreover, the performance of a score was evaluated by the receiver operating characteristic curve and the area under the curve (AUC). Compared to non-NEN, NEN significantly increased the risk of suicide to 1.8-fold (NEN vs. non-NEN; OR, 1.832; < 0.001). In addition, we observed that age, gender, race, marital status, tumor stage, histologic grade, surgery, and chemotherapy were associated with suicide among NEN patients; and a synthesized score based on these factors could significantly distinguish suicide individuals from non-suicide individuals in the training data set (AUC, 0.829; < 0.001) and in the validation data set (AUC, 0.735; < 0.001). This score also had a good performance when it was assessed by the test data set (AUC, 0.690; < 0.001). This demonstrates that the score might also be applicable to other cancer entities. This population-based study suggests that NEN patients have a higher risk of suicide than non-NEN patients. In addition, this study provided a score, which can identify NEN patients at high-risk of committing suicide. Thus, this score in combination with current screening and prevention strategies for suicide may improve life quality and life expectancy of NEN patients.
神经内分泌肿瘤（NEN）的诊断是否会增加患者自杀风险，目前尚未得到研究。识别有自杀风险的NEN患者对于提高他们的生活质量和预期寿命至关重要。从监测、流行病学和最终结果计划中提取癌症病例，并将其分为NEN队列和非NEN队列。随后，将NEN患者随机分为训练数据集和验证数据集。通过分析训练数据集，我们开发了一个用于评估NEN患者自杀风险的评分。此外，我们使用验证数据集对该评分进行验证，并通过测试数据集（一个非NEN队列）评估该评分是否也可应用于其他癌症实体。确定了NEN患者与非NEN患者之间自杀的比值比（OR）。此外，通过受试者工作特征曲线和曲线下面积（AUC）评估评分的性能。与非NEN相比，NEN显著将自杀风险增加至1.8倍（NEN与非NEN；OR，1.832；<0.001）。此外，我们观察到年龄、性别、种族、婚姻状况、肿瘤分期、组织学分级、手术和化疗与NEN患者的自杀有关；基于这些因素的综合评分在训练数据集中（AUC，0.829；<0.001）和验证数据集中（AUC，0.735；<0.001）能够显著区分自杀个体与非自杀个体。当通过测试数据集进行评估时，该评分也具有良好的性能（AUC，0.690；<0.001）。这表明该评分可能也适用于其他癌症实体。这项基于人群的研究表明，NEN患者比非NEN患者有更高的自杀风险。此外，本研究提供了一个评分，可识别有高自杀风险的NEN患者。因此，该评分与当前的自杀筛查和预防策略相结合，可能会提高NEN患者的生活质量和预期寿命。
