Fu Shen-Shen, Zheng Yu-Zhen, Qin Xian-Yu, Yang Xing-Ping, Shen Piao, Cai Wei-Jie, Li Xiao-Qiang, Liao Hong-Ying
Department of Ultrasonography, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China.
Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
J Thorac Dis. 2022 Jan;14(1):90-101. doi: 10.21037/jtd-21-1164.
For metachronous second pulmonary squamous cell carcinoma (msPSC) in patients with resected PSC, the method to distinguish tumour clonality has not yet been well established, which makes it difficult to determine accurate staging and predict prognosis.
Patients who underwent surgery for first PSC and encountered msPSC were recruited from the Surveillance, Epidemiology, and End Results (SEER) database. We extracted overall survival 1 (OS1) for the first PSC, overall survival 2 (OS2) for msPSC, and interval survival for the time interval between the first and second PSC. The nomogram was calibrated for OS2, and recursive partitioning analysis (RPA) was performed for risk stratification.
A total of 617 patients were identified. Several independent prognostic factors were identified and integrated into the nomogram for OS2, including gender, age (2), nodal status (1), node metastasis (2), and extrapulmonary metastasis (2). The calibration curves showed optimal agreement between the predictions and actual observations, and the c-index was 0.678. Surgery was associated with longer survival for msPSC patients. The prognosis of sublobectomy was comparable and inferior to that of lobectomy in the low- and moderate-risk groups, respectively. Radiotherapy was associated with better outcomes in patients who did not undergo surgery.
The RPA-based clinical nomogram appears to be suitable for the prognostic prediction and risk stratification of OS2 in msPSC. This practical system may help clinicians make decisions and design clinical studies.
对于已切除原发性肺鳞状细胞癌（PSC）的患者发生的异时性第二原发性肺鳞状细胞癌（msPSC），区分肿瘤克隆性的方法尚未完全确立，这使得准确分期和预测预后变得困难。
从监测、流行病学和最终结果（SEER）数据库中招募接受过首次PSC手术并出现msPSC的患者。我们提取了首次PSC的总生存期1（OS1）、msPSC的总生存期2（OS2）以及首次和第二次PSC之间时间间隔的间期生存期。对OS2的列线图进行校准，并进行递归划分分析（RPA）以进行风险分层。
共确定了617例患者。确定了几个独立的预后因素并将其纳入OS2的列线图中，包括性别、年龄（2分）、淋巴结状态（1分）、淋巴结转移（2分）和肺外转移（2分）。校准曲线显示预测值与实际观察值之间具有最佳一致性，c指数为0.678。手术与msPSC患者更长的生存期相关。在低风险和中等风险组中，亚肺叶切除术的预后分别与肺叶切除术相当但较差。放疗与未接受手术的患者更好的预后相关。
基于RPA的临床列线图似乎适用于msPSC中OS2的预后预测和风险分层。这个实用的系统可能有助于临床医生做出决策并设计临床研究。
