Liu Yong, Yang Miaomiao, Pang Zhaofei, Zhao Xiaogang, Ma Guoyuan, Zhao Qidi, Du Jiajun
Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China.
Department of Oncology, Yantai Yuhuangding Hospital, Affiliated with Medical College of Qingdao University, Yantai, 264000, Shandong, China.
Heliyon. 2023 Apr 8;9(4):e15319. doi: 10.1016/j.heliyon.2023.e15319. eCollection 2023 Apr.
Pulmonary neuroendocrine tumors, including small cell lung cancer (SCLC) and non-small cell neuroendocrine tumor (NSCLC-NET), have obvious heterogeneity. The comparison between SCLC and NSCLC-NET, and prognostic nomogram of resected NSCLC-NET have not been performed.
We retrieved data from SEER database. The incidence and prognostic factors were compared between SCLC and NSCLC-NET. By Cox regression, we constructed prognostic nomogram of resected NSCLC-NET. The nomogram was evaluated by ROC, calibration plot and decision curve analysis (DCA) and compared with 8th TNM staging system. A Chinese cohort was used for external validation.
The age-adjusted incidence of SCLC declined after 1991 but the incidence of NSCLC-NET continuously rose. Patients with typical carcinoid had the best prognosis in both overall survival and lung cancer specific survival, followed by atypical carcinoid, large cell neuroendocrine tumor and SCLC after operation. Patients receiving sleeve resection in NSCLC-NET had longer survival but segmental resection was more recommended in SCLC. High-smoking index was associated with worse overall survival in both SCLC and NSCLC-NET. Histological subtype, age, surgery type, N, M stage and chemotherapy were independent prognostic factors and used to construct prognostic nomogram of resected NSCLC-NET. The nomogram performed well with good discrimination, calibration and clinical usefulness, which was validated by a Chinese cohort (1, 3, 5-year AUC: SEER cohort 0.873, 0.901, 0.875; Chinese cohort 0.867, 0.892, 0.874). Compared to the 8th staging system, the nomogram had higher C-index (0.87 vs 0.728, < 0.001), clinical usefulness, increasing AUC value over time and improved 68%.
The prognostic nomogram of resected NSCLC-NET performed better than the 8th TNM staging system. It may have certain value in risk stratification and survival prediction of patients with resected NSCLC-NET and help clinicians to take measures for high-risk patients in advance.
肺神经内分泌肿瘤，包括小细胞肺癌（SCLC）和非小细胞神经内分泌肿瘤（NSCLC-NET），具有明显的异质性。尚未对SCLC和NSCLC-NET进行比较，也未构建切除的NSCLC-NET的预后列线图。
我们从SEER数据库中检索数据。比较SCLC和NSCLC-NET的发病率及预后因素。通过Cox回归，构建切除的NSCLC-NET的预后列线图。通过ROC曲线、校准图和决策曲线分析（DCA）对列线图进行评估，并与第8版TNM分期系统进行比较。使用一个中国队列进行外部验证。
1991年后，SCLC的年龄调整发病率下降，但NSCLC-NET的发病率持续上升。典型类癌患者在总生存期和肺癌特异性生存期方面预后最佳，其次是不典型类癌、大细胞神经内分泌肿瘤和术后的SCLC。NSCLC-NET患者接受袖状切除术的生存期更长，但SCLC更推荐节段性切除术。高吸烟指数与SCLC和NSCLC-NET的较差总生存期相关。组织学亚型、年龄、手术类型、N、M分期和化疗是独立的预后因素，并用于构建切除的NSCLC-NET的预后列线图。该列线图在区分度、校准和临床实用性方面表现良好，并得到一个中国队列的验证（1、3、5年AUC：SEER队列0.873、0.901、0.875；中国队列0.867、0.892、0.874）。与第8版分期系统相比，列线图具有更高的C指数（0.87对0.728，<0.001）、临床实用性，随着时间推移AUC值增加且提高了68%。
切除的NSCLC-NET的预后列线图比第8版TNM分期系统表现更好。它在切除的NSCLC-NET患者的风险分层和生存预测中可能具有一定价值，并有助于临床医生提前对高危患者采取措施。
