Wang Zhenfan, Li Hao, Liu Taorui, Sun Zewen, Yang Fan, Jiang Guanchao
Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China.
Front Oncol. 2021 Jul 19;11:645486. doi: 10.3389/fonc.2021.645486. eCollection 2021.
Non-small-cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination are defined as M1a in the eighth of American Joint Committee on Cancer (AJCC) TNM staging. We aimed to build a nomogram to predict lung cancer specific survival (LCSS) of NSCLC patients with ipsilateral pleural dissemination and to compare the impact of primary tumor resection (PTR) on LCSS among patients with different features.
A total of 3,918 NSCLC patients with ipsilateral pleural dissemination were identified from the Surveillance, Epidemiology, and End Results (SEER) database. We selected and integrated significant prognostic factors based on competing risk regression to build a nomogram. The model was subjected to internal validation within SEER cohort and external validation with the cohort of 97 patients from Peking University People's Hospital.
Age ( < 0.001), gender ( = 0.037), T stage ( = 0.002), N stage ( < 0.001), metastasis pattern ( = 0.005), chemotherapy ( < 0.001), and PTR ( < 0.001) were independent prognostic factors. The calibration curves presented a good consistency and the Harrell's C-index of nomogram were 0.682 (95%CI: 0.673-0.691), 0.687 (95%CI: 0.670-0.704) and 0.667 (95%CI: 0.584-0.750) in training, internal, and external validation cohort, respectively. Interaction tests suggested a greater LCSS difference caused by PTR in patients without chemotherapy (P < 0.001).
We developed a nomogram based on competing risk regression to reliably predict prognosis of NSCLC patients with ipsilateral pleural dissemination and validated this nomogram in an external Chinese cohort. This novel nomogram might be a practical tool for clinicians to anticipate the 1-, 3- and 5-year LCSS for NSCLC patients with pleural dissemination. Subgroup analysis indicated that patients without chemotherapy could get more benefit from PTR. In order to assess the role of PTR in the management of M1a patients more accurately, further prospective study would be urgently required.
在美国癌症联合委员会（AJCC）第八版TNM分期中，同侧胸膜播散的非小细胞肺癌（NSCLC）患者被定义为M1a期。我们旨在构建一个列线图，以预测同侧胸膜播散的NSCLC患者的肺癌特异性生存（LCSS），并比较不同特征患者中原发肿瘤切除（PTR）对LCSS的影响。
从监测、流行病学和最终结果（SEER）数据库中识别出3918例同侧胸膜播散的NSCLC患者。我们基于竞争风险回归选择并整合显著的预后因素来构建列线图。该模型在SEER队列中进行内部验证，并在北京大学人民医院的97例患者队列中进行外部验证。
年龄（<0.001）、性别（=0.037）、T分期（=0.002）、N分期（<0.001）、转移模式（=0.005）、化疗（<0.001）和PTR（<0.001）是独立的预后因素。校准曲线呈现出良好的一致性，列线图在训练、内部和外部验证队列中的Harrell's C指数分别为0.682（95%CI：0.673-0.691）、0.687（95%CI：0.670-0.704）和0.667（95%CI：0.584-0.750）。交互检验表明，在未接受化疗的患者中，PTR导致的LCSS差异更大（P<0.001）。
我们基于竞争风险回归开发了一个列线图，以可靠地预测同侧胸膜播散的NSCLC患者的预后，并在中国外部队列中验证了该列线图。这个新的列线图可能是临床医生预测胸膜播散的NSCLC患者1年、3年和5年LCSS的实用工具。亚组分析表明，未接受化疗的患者可能从PTR中获得更多益处。为了更准确地评估PTR在M1a期患者管理中的作用，迫切需要进一步的前瞻性研究。
