基于 SEER 数据库的肺癌亚型远处转移模式和原发肿瘤切除对转移性肺癌患者生存的影响。

Distant metastasis patterns among lung cancer subtypes and impact of primary tumor resection on survival in metastatic lung cancer using SEER database.

机构信息

Department of Cardiothoracic Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.

Key Laboratory of Molecular Medicine, Nanjing University, Nanjing, 210093, Jiangsu, China.

出版信息

Sci Rep. 2024 Sep 28;14(1):22445. doi: 10.1038/s41598-024-73389-6.

DOI:10.1038/s41598-024-73389-6

PMID:39341901

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11438988/

Abstract

This research aimed to systematically uncover the metastatic characteristics and survival rates of lung cancer subtypes and to evaluate the impact of surgery at the primary tumor site on cancer-specific survival in DM lung cancer. We used the Surveillance, Epidemiology, and End Results (SEER) database (2010-2019) to identify primary lung cancers with DM at presentation (M1). Kaplan-Meier (KM) survival curves were generated and compared utilizing log-rank tests. Cox regression methods were employed to determine hazard ratios (HR) and 95% confidence intervals related to CSS factors. Inverse probability of treatment weighting (IPTW) was applied to reduce bias. We analyzed 77,827 M1 lung cancer cases, with 41.22% having DM at presentation. Bone metastasis was most common in ADC, ASC, SCC, LCC; brain in LCNEC; liver in SCLC. Lung was common in TC + AC and SCC. Long-term survival was best in TC + AC and worst in SCLC (p < 0.001). Male gender, age < 50, primary tumor site (main bronchus, lower lobe), large tumor diameter, ADC/SCLC/SCC pathology, and regional lymph node involvement were significant risk factors for multiorgan metastasis. Age ≥ 50, male, large tumor diameter, positive lymph nodes, and multiorgan metastases were associated with lower CSS. In contrast, radiotherapy, chemotherapy, systemic therapy, and surgery were associated with higher CSS rates. Primary tumor resection improved survival in lung cancer patients (excluding small cell lung cancer, SCLC) with single organ metastases (KM log rank p < 0.001, HR = 0.6165; 95% CI (0.5468-0.6951)), especially in brain (p < 0.001, HR = 0.6467; 95% CI (0.5505-0.7596)) and bone (p = 0.182, HR = 0.6289; p < 0.01), but not in liver or intrapulmonary metastases after IPTW. Significant differences in DM patterns and corresponding survival rates exist among lung cancer subtypes. Primary tumor resection improves survival in lung cancer patients (excluding small cell lung cancer, SCLC) with single organ metastases, with better outcomes in patients with brain and bone metastases, while no significant benefit was seen in patients with liver and intrapulmonary metastases.

摘要

这项研究旨在系统地揭示肺癌亚型的转移特征和生存率，并评估原发性肿瘤部位手术对合并远处转移的肺癌患者癌症特异性生存的影响。我们使用监测、流行病学和最终结果（SEER）数据库（2010-2019 年），确定了以远处转移（M1）为首发表现的原发性肺癌。采用 Kaplan-Meier（KM）生存曲线并进行对数秩检验比较。采用 Cox 回归方法确定与 CSS 相关的危险比（HR）和 95%置信区间。采用逆概率治疗加权（IPTW）降低偏倚。我们分析了 77827 例 M1 肺癌病例，其中 41.22%的患者在就诊时合并远处转移。骨转移最常见于 ADC、ASC、SCC、LCC；脑转移最常见于 LCNEC；肝转移最常见于 SCLC。肺转移最常见于 TC+AC 和 SCC。TC+AC 和 SCC 的长期生存率最好，SCLC 的最差（p<0.001）。男性、年龄<50 岁、原发肿瘤部位（主支气管、下叶）、肿瘤直径大、ADC/SCLC/SCC 病理和区域淋巴结受累是多器官转移的显著危险因素。年龄≥50 岁、男性、肿瘤直径大、阳性淋巴结和多器官转移与较低的 CSS 相关。相反，放疗、化疗、全身治疗和手术与更高的 CSS 率相关。原发性肿瘤切除可改善单器官转移（不包括小细胞肺癌，SCLC）肺癌患者的生存（KM 对数秩 p<0.001，HR=0.6165；95%CI（0.5468-0.6951）），尤其是脑转移（p<0.001，HR=0.6467；95%CI（0.5505-0.7596））和骨转移（p=0.182，HR=0.6289；p<0.01），但在经过 IPTW 后肝转移和肺内转移无明显获益。肺癌各亚型的远处转移模式和相应的生存率存在显著差异。原发性肿瘤切除可改善单器官转移（不包括小细胞肺癌，SCLC）肺癌患者的生存，脑转移和骨转移患者获益更大，而肝转移和肺内转移患者无明显获益。