肺神经内分泌癌、伴有神经内分泌分化的腺癌及腺癌的生存比较
Survival comparison of pulmonary neuroendocrine carcinoma, adenocarcinoma with neuroendocrine differentiation, and adenocarcinoma.
作者信息
Tai Qidong, Bao Yi, Song Nan, Hu Xuefei, Duan Liang
机构信息
Department of Medicine, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Thoracic Department of Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
出版信息
J Thorac Dis. 2024 Jan 30;16(1):604-614. doi: 10.21037/jtd-23-1811. Epub 2024 Jan 17.
BACKGROUND
Pulmonary adenocarcinoma with neuroendocrine differentiation (ADE_ned) is a relatively uncommon pathological classification, and there exists considerable debate regarding its prognosis and treatment. The purpose of this study was to analyze the survival difference between patients with neuroendocrine carcinoma (NEC), adenocarcinoma (ADE), or ADE_ned and to investigate the prognostic factors influencing the outcomes of individuals diagnosed with pulmonary ADE_ned.
METHODS
We retrieved information on 316 cases of ADE_ned, 188,823 cases of ADE, and 71,154 cases of NEC diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. To account for potential confounding variables, propensity score matching (PSM) was employed. Comparative analyses were conducted to estimate the overall survival (OS) and cancer-specific survival (CSS). Finally, the Cox regression models were used to identify prognostic factors associated with pulmonary ADE_ned.
RESULTS
Prior to PSM, patients with lung ADE_ned had a worse OS rate than did those with lung ADE or NEC (5-year OS rate: 13.3% . 26.6% . 15.6%; P<0.001 and P=0.009, respectively). In terms of CSS, the 5-year CSS rate of patients with ADE_ned was superior to that of NEC but inferior to that of ADE (28.7% . 26.8% . 43.8%; P=0.006 and P<0.001, respectively). Following PSM, the 5-year survival rate of patients with ADE_ned remained lower than that of individuals with ADE or NEC in terms of OS (13.3% . 24.4% . 23.0%; P<0.001 and P<0001, respectively) and CSS (28.8% . 58.6% . 43.1%; P<0.001 and P=0.006, respectively). Finally, the results of the competitive risk regression analysis demonstrated that several variables, including sex, T stage, N stage, M stage, and surgery, were found to be independent prognostic factors for patients diagnosed with pulmonary ADE_ned (all P values <0.05).
CONCLUSIONS
Patients with lung ADE_ned had a significantly poorer survival outcome compared to those with lung ADE or NEC. Furthermore, sex, tumor-node-metastasis (TNM) stage, and surgery were found to be independent prognostic indicators for cases with lung ADE_ned.
背景
具有神经内分泌分化的肺腺癌（ADE_ned）是一种相对不常见的病理分类，关于其预后和治疗存在相当大的争议。本研究的目的是分析神经内分泌癌（NEC）、腺癌（ADE）或ADE_ned患者之间的生存差异，并调查影响诊断为肺ADE_ned患者预后的因素。
方法
我们从监测、流行病学和最终结果（SEER）数据库中检索了2004年至2015年间诊断的316例ADE_ned、188,823例ADE和71,154例NEC的信息。为了考虑潜在的混杂变量，采用了倾向评分匹配（PSM）。进行比较分析以估计总生存期（OS）和癌症特异性生存期（CSS）。最后，使用Cox回归模型来确定与肺ADE_ned相关的预后因素。
结果
在PSM之前，肺ADE_ned患者的OS率低于肺ADE或NEC患者（5年OS率：13.3%、26.6%、15.6%；P<0.001和P=0.009，分别）。在CSS方面，ADE_ned患者的5年CSS率优于NEC但低于ADE（28.7%、26.8%、43.8%；P=0.006和P<0.001，分别）。PSM后，ADE_ned患者的5年生存率在OS（13.3%、24.4%、23.0%；P<0.001和P<0.001，分别）和CSS（28.8%、58.6%、43.1%；P<0.001和P=0.006，分别）方面仍低于ADE或NEC患者。最后，竞争风险回归分析结果表明，包括性别、T分期、N分期、M分期和手术在内的几个变量被发现是诊断为肺ADE_ned患者的独立预后因素（所有P值<0.05）。
结论
与肺ADE或NEC患者相比，肺ADE_ned患者的生存结果明显较差。此外，性别、肿瘤-淋巴结-转移（TNM）分期和手术被发现是肺ADE_ned病例的独立预后指标。
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