Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Thorac Cancer. 2022 Feb;13(4):539-548. doi: 10.1111/1759-7714.14289. Epub 2021 Dec 30.
Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine tumor with a short replication time and a rapid growth rate. Prognostic factors for SCLC in clinical practice are scarce. Retrospective analysis of 8-year extensive-stage SCLC data from the Department Respiratory and Intensive Care Unit, Peking Union Medical College Hospital (Beijing, China) was performed to develop a risk prediction model that can facilitate the identification of extensive-stage SCLC with differing prognosis in clinical practice.
A retrospective analysis of data from patients with extensive-stage SCLC at a single-center from January 2013 to January 2021, including age, sex, ECOG physical score, immunohistochemistry (CgA, Syn, CD56, TTF1, and Ki67), staging, treatment regimen, laboratory examinations, and survival period, was performed. Clinical variables with potential prognostic significance were screened by univariate Cox analysis. Next, multifactor Cox risk prediction regression analysis was performed to establish an extensive-stage SCLC risk prognostic model. Survival curves and ROC curves for high and low risk groups were plotted according to risk scores. Nomogram and calibration curves were developed to assess the accuracy of the risk prediction model.
This study included 300 patients who were diagnosed with extensive-stage SCLC at our center from January 2013 to January 2021. The most common first presentation was respiratory symptoms, especially cough (162, 54%). The most common extra-thoracic metastatic organs were bone (36.3%), liver (24.7%), brain (15.7%), and adrenal glands (15.7%). A total of 99% of patients received first-line systemic therapy, with 86.3% of patients treated with platinum-etoposide and 10.7% of patients treated with immune checkpoint inhibitor combined with platinum-etoposide backbone. First-line progression-free survival was up to 198 days, and the median OS was 439 days. After Cox regression screening and backward stepwise selection, "time from initial therapy to relapse or progression (PFS1), liver metastases, adrenal metastases, M stage and first-line treatment pattern" were retained to establish a prognostic model with an AUC value of 0.763. The prognostic model was shown as a nomogram with good agreement between predicted and observed outcomes.
The first-line treatment of SCLC patients admitted to our hospital in the past 8 years was relatively standardized, and the progression-free survival and OS were slightly longer than those reported in the literature. We developed a prognostic risk score model for extensive-stage SCLC to calculate individual survival in clinical practice.
小细胞肺癌（SCLC）是一种具有高度侵袭性的神经内分泌肿瘤，其复制时间短，生长速度快。在临床实践中，SCLC 的预后因素很少。对北京协和医院呼吸与危重症医学科 8 年来广泛期 SCLC 数据进行回顾性分析，旨在建立一个风险预测模型，以便在临床实践中识别具有不同预后的广泛期 SCLC。
对 2013 年 1 月至 2021 年 1 月期间在我院接受治疗的广泛期 SCLC 患者的临床数据进行回顾性分析，包括年龄、性别、ECOG 体能评分、免疫组化（CgA、Syn、CD56、TTF1、Ki67）、分期、治疗方案、实验室检查和生存时间。采用单因素 Cox 分析筛选有潜在预后意义的临床变量。然后，采用多因素 Cox 风险预测回归分析建立广泛期 SCLC 风险预测模型。根据风险评分绘制高、低风险组的生存曲线和 ROC 曲线。绘制列线图和校准曲线以评估风险预测模型的准确性。
本研究共纳入了 2013 年 1 月至 2021 年 1 月期间在我院确诊的 300 例广泛期 SCLC 患者。最常见的首发症状是呼吸系统症状，尤其是咳嗽（162 例，54%）。最常见的远处转移器官是骨骼（36.3%）、肝脏（24.7%）、脑（15.7%）和肾上腺（15.7%）。99%的患者接受了一线全身治疗，86.3%的患者接受了铂类联合依托泊苷治疗，10.7%的患者接受了免疫检查点抑制剂联合铂类依托泊苷治疗。一线无进展生存期最长可达 198 天，中位 OS 为 439 天。经过 Cox 回归筛选和后向逐步选择，“初始治疗至复发或进展的时间（PFS1）、肝转移、肾上腺转移、M 分期和一线治疗方案”被保留下来，建立了一个 AUC 值为 0.763 的预后模型。该预后模型以列线图的形式呈现，预测结果与观察结果具有良好的一致性。
过去 8 年来我院收治的 SCLC 患者的一线治疗相对规范，无进展生存期和 OS 略长于文献报道。我们建立了一个广泛期 SCLC 的预后风险评分模型，以计算临床实践中的个体生存。
