Wang Tengyong, Wang Zihuai, Zhou Jian, Jie Hui, Liao Hu, Mei Jiandong, Pu Qiang, Liu Lunxu
Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
Transl Lung Cancer Res. 2024 Aug 31;13(8):1841-1850. doi: 10.21037/tlcr-24-338. Epub 2024 Aug 8.
The risk and risk factors of extrathoracic metastasis at initial diagnosis in TN lung cancer patients are not fully understood. We aimed to develop a model to predict the risk of extrathoracic metastasis in those patients.
Clinicopathological data of patients were collected from Surveillance, Epidemiology, and End Results (SEER) database. Univariable and multivariable analyses using logistic regression were conducted to identify risk factors. A predictive model and corresponding nomogram were developed based on the risk factors. The model was assessed using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow test, and decision curve.
A total of 20,057 TN patients were enrolled, of whom 251 (1.25%) were diagnosed with extrathoracic metastasis at the initial diagnosis. Aged ≤50 [odds ratio (OR): 2.05, 95% confidence interval (CI): 1.19-3.53, P=0.01] and aged ≥81 [1.65 (1.05-2.58), P=0.03], Hispanic [1.81 (1.20-2.71), P=0.004], location of bronchus [3.18 (1.08-9.35), P=0.04], larger tumor size, pleural invasion, and a history of colorectal cancer [2.01 (1.01-4.00), P=0.046] were independent risk factors. In the training cohort and validation cohort, the AUCs of the developed model were 0.727, 0.728 respectively, and the results of Hosmer-Lemeshow test were P=0.47, P=0.61 respectively. The decision curve showed good clinical meaning of the model.
Extrathoracic metastasis at initial diagnosis in TN lung cancer patients was not rare. The model based on the risk factors showed good performance in predicting the risk of extrathoracic metastasis.
TN 期肺癌患者初诊时胸外转移的风险及危险因素尚未完全明确。我们旨在建立一个模型来预测这些患者胸外转移的风险。
从监测、流行病学和最终结果（SEER）数据库收集患者的临床病理数据。采用逻辑回归进行单变量和多变量分析以确定危险因素。基于危险因素建立预测模型和相应的列线图。使用受试者操作特征曲线下面积（AUC）、Hosmer-Lemeshow 检验和决策曲线对模型进行评估。
共纳入 20,057 例 TN 期患者，其中 251 例（1.25%）在初诊时被诊断为胸外转移。年龄≤50 岁[比值比（OR）：2.05，95%置信区间（CI）：1.19 - 3.53，P = 0.01]、年龄≥81 岁[1.65（1.05 - 2.58），P = 0.03]、西班牙裔[1.81（1.20 - 2.71），P = 0.004]、支气管位置[3.18（1.08 - 9.35），P = 0.04]、肿瘤体积较大、胸膜侵犯以及有结直肠癌病史[2.01（1.01 - 4.00），P = 0.046]是独立危险因素。在训练队列和验证队列中，所建立模型的 AUC 分别为 0.727、0.728，Hosmer-Lemeshow 检验结果分别为 P = 0.47、P = 0.61。决策曲线显示该模型具有良好的临床意义。
TN 期肺癌患者初诊时胸外转移并不罕见。基于危险因素的模型在预测胸外转移风险方面表现良好。
