Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Oncology, Dongying People's Hospital, Dongying, Shandong, China.
Clin Respir J. 2024 Oct;18(10):e70017. doi: 10.1111/crj.70017.
Staged bilateral surgery is widely used to treat synchronous multiple primary lung cancer (SMPLC); however, the prognostic factors for survival outcomes remain unclear. This study aimed to identify prognostic factors and construct a predictive model for overall survival (OS) and recurrence-free survival (RFS) in patients with SMPLC who underwent staged bilateral surgery.
The study included 256 patients diagnosed with SMPLC and treated with staged bilateral surgery at our hospital between January 2010 and July 2017. Multivariate Cox proportional-hazard regression was used to identify prognostic factors for OS and RFS. Additionally, a predictive model was constructed using time-dependent receiver operating characteristic curves.
Among the 256 patients, 10 (3.95%) succumbed to the disease and 24 (9.41%) experienced recurrence. Smoking (hazard ratio [HR]: 5.128; 95% confidence interval [CI]: 1.442-18.233; p = 0.012) and most advanced pathological TNM (pTNM) stage (II + III) (HR: 12.938; 95% CI: 2.650-63.176; p = 0.002) were identified as significant predictors of poor OS. A prognostic model was developed for predicting OS, with a 5-year area under the curve (AUC) of 0.854. Furthermore, most advanced pTNM stage (II + III) was associated with poor RFS (HR: 5.964; 95% CI: 2.669-13.327; p < 0.001), and the predictive model exhibited a 5-year AUC of 0.718 for RFS.
This study revealed that smoking and most advanced pTNM stage were independent prognostic factors associated with poor OS in patients with bilateral SMPLC. Moreover, most advanced pTNM stage was also linked to unfavorable RFS. The developed predictive model demonstrated moderate prognostic performance for both OS and RFS.
分期双侧手术广泛用于治疗同步多原发性肺癌（SMPLC）；然而，生存结果的预后因素仍不清楚。本研究旨在确定分期双侧手术治疗 SMPLC 患者的总生存（OS）和无复发生存（RFS）的预后因素，并构建预测模型。
本研究纳入了 2010 年 1 月至 2017 年 7 月在我院接受分期双侧手术治疗的 256 例 SMPLC 患者。采用多变量 Cox 比例风险回归分析识别 OS 和 RFS 的预后因素。此外，使用时间依赖性接收器操作特征曲线构建预测模型。
在 256 例患者中，有 10 例（3.95%）死于该疾病，24 例（9.41%）发生复发。吸烟（风险比[HR]：5.128；95%置信区间[CI]：1.442-18.233；p=0.012）和最晚期病理 TNM（pTNM）分期（II+III）（HR：12.938；95%CI：2.650-63.176；p=0.002）被确定为 OS 不良的显著预测因素。建立了一个预测 OS 的模型，其 5 年 AUC 为 0.854。此外，最晚期 pTNM 分期（II+III）与 RFS 不良相关（HR：5.964；95%CI：2.669-13.327；p<0.001），预测模型的 RFS 5 年 AUC 为 0.718。
本研究表明，吸烟和最晚期 pTNM 分期是双侧 SMPLC 患者 OS 不良的独立预后因素。此外，最晚期 pTNM 分期与不利的 RFS 相关。所开发的预测模型对 OS 和 RFS 均具有中等的预后性能。
