Yu Wenze, Long Lu, Hou Qizhuo, Yi Bin
Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.
PLoS One. 2025 Apr 29;20(4):e0321955. doi: 10.1371/journal.pone.0321955. eCollection 2025.
The upper lobe is the most common site of primary lung cancer, however, very few reports focus on its prognosis. This study aims to identify prognostic factors of lung cancer in the upper lobe, as well as to establish an effective nomogram for individualized overall survival (OS) prediction.
Patients diagnosed with lung cancer were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database for the period of 2010-2017,as recorder in the 2021 SEER database release. The demographic characteristics and OS differed in the primary sites of the upper, middle and lower lobes were drawn. The primary upper lobe lung cancer patients were further stratified by the risk indicators including Mets at DX-bone, stage, histology, grade and sex; and their OS differences in stratification were compared by the Kaplan-Meier method and the Log-Rank test. The univariate and the multivariate Cox regression were employed to determine the independent prognostic factors for the primary upper lobe lung cancer and to build a nomogram model for its OS prediction.
Depending on the different primary sites of lung cancer occurrence, all the collected patients were divided into three groups of the upper lobe (30295 individuals), the middle lobe (2801 individuals) and the lower lobe (16757 individuals), where the upper lobe group gained our attention with the largest population and an overwhelmingly low OS compared to the middle lobe group (P <0.0001). With the results of the univariate and multivariate Cox regression model analyses, age, sex, grade, histology type, stage, regional lymph nodes removed, bone metastasis and liver metastasis were selected as the prognostic factors and a prediction nomogram model was built. The calibration curves showed no significant bias from the reference line and the concordance index between the survival nomogram prediction and the actual outcome for 2-year and 3-year OS was 0.761 (95% CI, 0.757-0.765). The time-dependent receiver operating characteristic curves showed that the areas under curve for 2-year and 3-year OS were 0.840 and 0.836, respectively.
A novel nomogram was established which achieved good performance in predicting the probability of OS in the primary upper lobe lung cancer, indicating its potential value in individualized prediction of the clinical outcome in these patients.
上叶是原发性肺癌最常见的部位，然而，很少有报告关注其预后情况。本研究旨在确定上叶肺癌的预后因素，并建立一个有效的列线图用于个体化总生存期（OS）预测。
从监测、流行病学和最终结果计划（SEER）数据库中收集2010 - 2017年诊断为肺癌的患者信息，这些信息记录在2021年SEER数据库版本中。绘制了上叶、中叶和下叶不同原发部位患者的人口统计学特征和总生存期差异。将原发性上叶肺癌患者根据诊断时骨转移（Mets at DX - bone）、分期、组织学类型、分级和性别等风险指标进一步分层；采用Kaplan - Meier法和对数秩检验比较各分层中患者的总生存期差异。采用单因素和多因素Cox回归确定原发性上叶肺癌的独立预后因素，并构建用于总生存期预测的列线图模型。
根据肺癌发生的不同原发部位，将所有收集的患者分为上叶组（30295例）、中叶组（2801例）和下叶组（16757例），其中上叶组人数最多且与中叶组相比总生存期极低，引起了我们的关注（P <0.0001）。通过单因素和多因素Cox回归模型分析结果，选择年龄、性别、分级、组织学类型、分期、切除的区域淋巴结、骨转移和肝转移作为预后因素，并构建了预测列线图模型。校准曲线显示与参考线无显著偏差，生存列线图预测与2年和3年总生存期实际结果之间的一致性指数为0.761（95%CI，0.757 - 0.765）。时间依赖性受试者工作特征曲线显示，2年和3年总生存期的曲线下面积分别为0.840和0.836。
建立了一种新型列线图，在预测原发性上叶肺癌总生存期概率方面表现良好，表明其在这些患者临床结局个体化预测中的潜在价值。
