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基于监测、流行病学和最终结果(SEER)数据库的研究:可切除的同侧肺转移非小细胞肺癌的预后因素和生存预测。

Prognostic factors and survival prediction of resected non-small cell lung cancer with ipsilateral pulmonary metastases: a study based on the Surveillance, Epidemiology, and End Results (SEER) database.

机构信息

Ningxia Medical University, Yinchuan, 750004, People's Republic of China.

Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, 750004, China.

出版信息

BMC Pulm Med. 2023 Oct 30;23(1):413. doi: 10.1186/s12890-023-02722-y.

Abstract

BACKGROUND

Prognostic factors and survival outcomes of non-small cell lung cancer (NSCLC) with Ipsilateral pulmonary metastasis (IPM) are not well-defined. Thus, this study intended to identify the prognostic factors for these patients and construct a predictive nomogram model.

METHODS

One thousand, seven hundred thirty-two patients with IPM identified between 2000 to 2019 were from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors were identified using multivariate Cox regression analyses. Nomograms were constructed to predict the overall survival (OS), C-index, the area under the curve (AUC), and the calibration curve to determine the predictive accuracy and discrimination; the decision curve analysis was used to confirm the clinical utility.

RESULTS

Patients were randomly divided into training (n = 1213) and validation (n = 519) cohorts. In the training cohort, the multivariable analysis demonstrated that age, sex, primary tumor size, N status, number of regional lymph nodes removed, tumor grade, and chemotherapy were independent prognostic factors for IPM. We constructed a 1-year, 3-year, and 5-year OS prediction nomogram model using independent prognostic factors. The C-index of this model for OS prediction was 0.714 (95% confidence interval [CI], 0.692 to 0.773) in the training cohort and 0.695 (95% CI, 0.660 to 0.730) in the validation cohort. Based on the AUC of the receiver operating characteristic analysis, calibration plots, and decision curve analysis, we concluded that the prognosis model of IPM exhibited excellent performance. Patients with total nomogram points greater than 96 were considered high-risk.

CONCLUSION

We constructed and internally validated a nomogram to predict 1-year, 3-year, and 5-year OS for NSCLC patients with IPM according to independent prognostic factors. This nomogram demonstrated good calibration, discrimination, clinical utility, and practical decision-making effects for the prognosis of NSCLC patients with IPM.

摘要

背景

同侧肺转移(IPM)的非小细胞肺癌(NSCLC)的预后因素和生存结果尚不清楚。因此,本研究旨在确定这些患者的预后因素,并构建预测列线图模型。

方法

从监测、流行病学和最终结果(SEER)数据库中,选择了 2000 年至 2019 年间的 1732 例 IPM 患者。使用多变量 Cox 回归分析确定独立的预后因素。构建列线图来预测总生存期(OS)、C 指数、曲线下面积(AUC)和校准曲线以确定预测准确性和区分度;决策曲线分析用于确认临床实用性。

结果

患者被随机分为训练(n=1213)和验证(n=519)队列。在训练队列中,多变量分析表明,年龄、性别、原发肿瘤大小、N 状态、切除的区域淋巴结数量、肿瘤分级和化疗是 IPM 的独立预后因素。我们使用独立的预后因素构建了一个用于预测 IPM 患者 1 年、3 年和 5 年 OS 的列线图模型。该模型在训练队列中预测 OS 的 C 指数为 0.714(95%置信区间 [CI],0.692 至 0.773),在验证队列中为 0.695(95% CI,0.660 至 0.730)。基于受试者工作特征分析的 AUC、校准图和决策曲线分析,我们得出结论,该 IPM 预后模型表现出优异的性能。总列线图点数大于 96 的患者被认为是高危患者。

结论

根据独立的预后因素,我们构建并内部验证了一个列线图,用于预测 NSCLC 伴 IPM 患者的 1 年、3 年和 5 年 OS。该列线图在预测 NSCLC 伴 IPM 患者的预后方面具有良好的校准度、区分度、临床实用性和实际决策效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10614355/0cd7784ea969/12890_2023_2722_Fig1_HTML.jpg

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