Department of Radiation Oncology, The Second Affiliated Hospital, Dalian Medical University, Dalian, China.
Front Endocrinol (Lausanne). 2022 Oct 17;13:973091. doi: 10.3389/fendo.2022.973091. eCollection 2022.
Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rapidly progressive and easily metastatic high-grade lung cancer, with a poor prognosis when distant metastasis (DM) occurs. The aim of our study was to explore risk factors associated with DM in LCNEC patients and to perform survival analysis and to develop a novel nomogram-based predictive model for screening risk populations in clinical practice.
The study cohort was derived from the Surveillance, Epidemiology, and End Results database, from which we selected patients with LCNEC between 2004 to 2015 and formed a diagnostic cohort (n = 959) and a prognostic cohort (n = 272). The risk and prognostic factors of DM were screened by univariate and multivariate analyses using logistic and Cox regressions, respectively. Then, we established diagnostic and prognostic nomograms using the data in the training group and validated the accuracy of the nomograms in the validation group. The diagnostic nomogram was evaluated using receiver operating characteristic curves, decision curve analysis curves, and the GiViTI calibration belt. The prognostic nomogram was evaluated using receiver operating characteristic curves, the concordance index, the calibration curve, and decision curve analysis curves. In addition, high- and low-risk groups were classified according to the prognostic monogram formula, and Kaplan-Meier survival analysis was performed.
In the diagnostic cohort, LCNEC close to bronchus, with higher tumor size, and with higher N stage indicated higher likelihood of DM. In the prognostic cohort (patients with LCNEC and DM), men with higher N stage, no surgery, and no chemotherapy had poorer overall survival. Patients in the high-risk group had significantly lower median overall survival than the low-risk group.
Two novel established nomograms performed well in predicting DM in patients with LCNEC and in evaluating their prognosis. These nomograms could be used in clinical practice for screening of risk populations and treatment planning.
肺大细胞神经内分泌癌（LCNEC）是一种进展迅速且易转移的高级别肺癌，当发生远处转移（DM）时预后较差。本研究旨在探讨与 LCNEC 患者 DM 相关的危险因素，并进行生存分析，建立一种基于新的列线图的预测模型，以便在临床实践中筛选高危人群。
本研究队列来自监测、流行病学和最终结果数据库，从中选择了 2004 年至 2015 年间患有 LCNEC 的患者，形成了诊断队列（n = 959）和预后队列（n = 272）。使用逻辑回归和 Cox 回归进行单因素和多因素分析，筛选 DM 的风险和预后因素。然后，我们使用训练组的数据建立诊断和预后列线图，并在验证组中验证列线图的准确性。使用受试者工作特征曲线、决策曲线分析曲线和 GiViTI 校准带评估诊断列线图的准确性。使用受试者工作特征曲线、一致性指数、校准曲线和决策曲线分析曲线评估预后列线图的准确性。此外，根据预后列线图公式对高危和低危组进行分类，并进行 Kaplan-Meier 生存分析。
在诊断队列中，靠近支气管的 LCNEC、较大的肿瘤大小和较高的 N 期表明 DM 的可能性更高。在预后队列（患有 LCNEC 和 DM 的患者）中，男性 N 期较高、未接受手术和未接受化疗的患者总生存率较低。高危组患者的中位总生存率明显低于低危组患者。
两种新建立的列线图在预测 LCNEC 患者的 DM 发生和评估其预后方面表现良好。这些列线图可用于临床实践中高危人群的筛查和治疗计划。
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