Beijing Chao-Yang Hospital, 74639Capital Medical University, Beijing, China.
71043Beijing Fu Xing Hospital, Capital Medical University, Beijing, China.
Technol Cancer Res Treat. 2022 Jan-Dec;21:15330338211068960. doi: 10.1177/15330338211068960.
Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of nonsmall cell lung cancer with a poor prognosis. This study aimed to analyze the clinicopathological characteristics and survival outcomes among patients with PSC, lung squamous cell cancer (SCC), and lung adenocarcinoma (LAC), and to construct a competing risk nomogram for patients with PSC. Data of 3 groups of patients diagnosed with PSC, SCC, or LAC from the surveillance, epidemiology, and end results (SEER) database between 1988 and 2015 were retrospectively reviewed. A 1:1 propensity score matching (PSM) analysis was used to balance the baseline data of patients. Independent risk factors associated with survival outcomes were screened by the least absolute shrinkage and selection operator and further determined by univariate and multivariate Cox proportional risk regression analyses. The overall survival (OS) of patients was evaluated by Kaplan-Meier analysis and compared with a log-rank test. The cumulative incidence function was used to estimate the 5-year probabilities of the cancer-specific mortality of PSC. A nomogram was constructed to illustrate the competing risk model to predict the 3- and 5-year OS, and corresponding concordance indexes (C-indexes) and calibration curves were used to assess and validate the competing risk nomogram. A total of 2285 patients with PSC were included in this study. Compared with SCC and LAC patients, the Kaplan-Meier analysis showed that patients with PSC had a worse prognosis, with a median survival of 5 months (95% confidence interval [CI]: 5-6 months) and a 5-year OS rate of 15.3% (95% CI: 13.9%-16.9%). Similar outcomes were demonstrated after 1:1 PSM. Moreover, the competing risk model showed that age, T stage, M stage, tumor size, lymph node ratio (LNR), surgery, and chemotherapy were associated with PSC-specific mortality. The 5-year C-index of the nomogram was 0.718. Calibration curves illustrated that the nomogram was well-validated and had great accuracy. Patients with PSC had a worse survival outcome compared with SCC or LAC patients. Age, T stage, M stage, tumor size, LNR, surgery, and chemotherapy were associated with PSC-specific mortality. The competing risk nomogram displayed excellent discrimination in predicting PSC-specific mortality.
肺肉瘤样癌（PSC）是一种罕见的非小细胞肺癌亚型，预后较差。本研究旨在分析 PSC、肺鳞癌（SCC）和肺腺癌（LAC）患者的临床病理特征和生存结局，并为 PSC 患者构建竞争风险列线图。
回顾性分析了 1988 年至 2015 年间监测、流行病学和最终结果（SEER）数据库中诊断为 PSC、SCC 或 LAC 的 3 组患者的数据。采用 1:1 倾向评分匹配（PSM）分析来平衡患者的基线数据。采用最小绝对收缩和选择算子筛选与生存结局相关的独立危险因素，并通过单因素和多因素 Cox 比例风险回归分析进一步确定。采用 Kaplan-Meier 分析评估患者的总生存率（OS），并采用对数秩检验进行比较。采用累积发生率函数估计 PSC 患者 5 年癌症特异性死亡率的概率。构建列线图以说明竞争风险模型，预测 3 年和 5 年 OS，并用相应的一致性指数（C 指数）和校准曲线评估和验证竞争风险列线图。
本研究共纳入 2285 例 PSC 患者。与 SCC 和 LAC 患者相比，Kaplan-Meier 分析显示 PSC 患者预后较差，中位生存时间为 5 个月（95%置信区间[CI]：5-6 个月），5 年 OS 率为 15.3%（95%CI：13.9%-16.9%）。在 1:1 PSM 后也得到了类似的结果。此外，竞争风险模型显示，年龄、T 分期、M 分期、肿瘤大小、淋巴结比值（LNR）、手术和化疗与 PSC 特异性死亡率相关。列线图的 5 年 C 指数为 0.718。校准曲线表明该列线图具有良好的验证效果和准确性。
与 SCC 或 LAC 患者相比，PSC 患者的生存结局较差。年龄、T 分期、M 分期、肿瘤大小、LNR、手术和化疗与 PSC 特异性死亡率相关。竞争风险列线图在预测 PSC 特异性死亡率方面具有良好的区分能力。
