Hai Tao, Zhou Lin, Wang Jingqiu, Wei Hao, Wang Yishun, Tian Tian, Wu Wangchun, Mei Ting
Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Transl Cancer Res. 2022 Jul;11(7):2122-2134. doi: 10.21037/tcr-22-462.
This study aims to discriminate risk factors associated with early death (died within 3 months) in metastatic small-cell lung cancer (SCLC) patients, and construct predictive nomograms to help physicians in guiding individual treatment.
Surveillance, Epidemiology, and End Results (SEER) database was used to obtain records of deceased metastatic SCLC patients. The univariate and multivariate logistic regression methods were managed to identify risk factors for early death in overall patients and chemotherapy recipients. Predictive nomograms were developed and then validated by receiver operating characteristics curve (ROC) and calibration plots to verify its' precision.
A total of 13,229 patients were collected of which 5,832 of them encountered early death. The univariate and multivariate logistic regression analysis identified variables that were negatively associated with early death include sex, age, race, sequence, T stage, N stage, organ metastasis. Chemotherapy and radiotherapy implementation significantly decreased the odds of early death. For the chemotherapy recipients, white male patients with advanced age (over 80 years old), T4 stage, multiple organ metastasis, and without radiotherapy most likely died within 3 months. The area under the curve (AUC) of the nomograms for overall population and chemotherapy recipients' early death prediction was 0.839 and 0.653.
Early death among metastatic SCLC patients was extremely common in clinical practice. The nomograms constructed were able to assist clinical physicians in discriminating high-risk SCLC patients for targeted intervention, and elderly white male patients diagnosed with advanced T stage and multiple organ metastasis might be exempted from systemic treatment to receive palliative care.
本研究旨在鉴别转移性小细胞肺癌（SCLC）患者早期死亡（3个月内死亡）的相关危险因素，并构建预测列线图以帮助医生指导个体化治疗。
利用监测、流行病学和最终结果（SEER）数据库获取已故转移性SCLC患者的记录。采用单因素和多因素逻辑回归方法确定总体患者和接受化疗患者早期死亡的危险因素。绘制预测列线图，然后通过受试者工作特征曲线（ROC）和校准图进行验证，以检验其准确性。
共收集13229例患者，其中5832例早期死亡。单因素和多因素逻辑回归分析确定与早期死亡呈负相关的变量包括性别、年龄、种族、序列、T分期、N分期、器官转移。实施化疗和放疗显著降低了早期死亡的几率。对于接受化疗的患者，高龄（80岁以上）、T4期、多器官转移且未接受放疗的白人男性患者最有可能在3个月内死亡。总体人群和接受化疗患者早期死亡预测列线图的曲线下面积（AUC）分别为0.839和0.653。
转移性SCLC患者的早期死亡在临床实践中极为常见。构建的列线图能够帮助临床医生鉴别高危SCLC患者以进行靶向干预，诊断为晚期T期和多器官转移的老年白人男性患者可能无需接受全身治疗而接受姑息治疗。
