Wang Zhidong, Gong Cheng, Zhang Youpu, Qian Yongxiang, Liu Yang, Chao Ce
Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China.
Transl Cancer Res. 2025 Feb 28;14(2):1024-1036. doi: 10.21037/tcr-24-1419. Epub 2025 Feb 26.
Although a strong survival benefit has been observed among small cell lung cancer (SCLC) patients undergoing surgery, not all SCLC patients benefit from surgery. To help clinicians make choices and decisions regarding surgical intervention, we have developed an effective model to screen beneficial candidates based on population and tumor characteristics.
Patients with SCLC were acquired from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was performed to balance covariates between the surgery and non-surgery groups. We assumed that patients undergoing surgery between 2014 and 2018 would benefit from the procedure if their median cancer-specific survival (CSS) time was longer than that of non-surgical patients. Univariate and multivariable logistic analyses were used to identify independent factors of surgical benefit in the surgery group. According to these preoperative factors, a nomogram was built and then internal and external validation were performed.
In total, 35,214 patients with complete data were included for subsequent analysis, 1,364 of whom underwent surgery. Before and after PSM, surgery was an independent factor of long-term survival, with a median CSS time of 37.00 months for the surgery group compared to 16.00 months for the non-surgery group. A multivariable logistic model identified T stage, N stage, M stage, tumor site, and age as independent factors, which were used to establish a stable predictive model.
We have built a preoperative predictive model for SCLC patients to screen for optimal surgery candidates. This model has the potential to help clinicians determine whether it is beneficial to operate on patients with SCLC.
尽管在接受手术的小细胞肺癌（SCLC）患者中观察到了显著的生存获益，但并非所有SCLC患者都能从手术中获益。为了帮助临床医生在手术干预方面做出选择和决策，我们开发了一种有效的模型，根据人群和肿瘤特征筛选出可能受益的患者。
从监测、流行病学和最终结果数据库中获取SCLC患者。进行倾向评分匹配（PSM）以平衡手术组和非手术组之间的协变量。我们假设，2014年至2018年接受手术的患者，如果其癌症特异性生存（CSS）时间中位数长于非手术患者，则会从该手术中获益。使用单变量和多变量逻辑分析来确定手术组中手术获益的独立因素。根据这些术前因素构建列线图，然后进行内部和外部验证。
总共纳入35214例具有完整数据的患者进行后续分析，其中1364例接受了手术。PSM前后，手术是长期生存的独立因素，手术组的CSS时间中位数为37.00个月，而非手术组为16.00个月。多变量逻辑模型确定T分期、N分期、M分期、肿瘤部位和年龄为独立因素，用于建立稳定的预测模型。
我们为SCLC患者建立了术前预测模型，以筛选出最佳手术候选者。该模型有可能帮助临床医生确定对SCLC患者进行手术是否有益。
