第二原发非小细胞肺癌患者的预后分析

Analysis of Prognostic Factors on Second Primary Non-Small Cell Lung Cancer

摘要: 背景与目的：随着原发肺癌幸存者人数的增加，第二原发肺癌的患者也越来越多。目前已经有大量对于第二原发肺癌的潜在风险因素以及预后模型的研究。但是对于第二原发非小细胞肺癌的危险因素以及预后模型这方面的研究较为匮乏。本篇文章旨在建立一种有效的第二原发非小细胞肺癌预后列线图。方法：本篇文章纳入了美国SEER数据库中的第二原发非小细胞肺癌数据，采用单因素和多因素分析研究了第二原发非小细胞肺癌患者的独立相关因素，以此构建了列线图并进行了验证。结果：我们一共纳入22,978名符合条件的第二原发非小细胞肺患者。在建模队列中，3年OS率为43.40%，5年OS率为21.38%。年龄，性别，诊断年份，分化等级，AJCC TNM分期，组织类型、肿瘤大小、清扫淋巴结组数、放疗、化疗和手术方式被认为是影响预后的因素。所建立的诺模图的C-Index为0.771 (95% CI (0.769, 0.773))，而且AUC曲线、临床决策曲线和校准图3年和5年的结果也证明了已建立的诺模图具有可靠的预测预后能力。结论：年龄，性别，种族，诊断年份，分化等级，AJCC TNM分期，组织类型、肿瘤大小、清扫淋巴结组数、放疗、化学治疗和手术方式是第二原发非小细胞肺癌预后的独立预测因素。本篇文章以此构建的列线图可以较好地预测患者预后。

Abstract: Purpose: As the number of primary lung cancer survivors increases, there are more and more sec-ond primary lung cancer patients. While numerous studies have examined potential risk factors and predictive models for SPLC, risk factors and predictive model are still lacking among Second Primary Non-small Cell Lung Cancer patients. This study aimed to establish an effective prognostic nomogram for second primary non-small cell lung cancer (SPNSCLC). Patients and Methods: The ar-ticle obtained the data of SPNSCLC patients in the Surveillance, Epidemiology, and End Results (SEER) database of the United States. Then we used univariate and multivariate analyses to explore the independent prognostic factors of SPNSCLC. Finally, we constructed and validated a nomogram to predict the outcomes of SPNSCLC. Results: 16,084 eligible DPLC patients were included in this study cohort, with 43.40% of 3-year OS rate and 21.38% of 5-year OS rate. Age, sex, grade, marital status, AJCC TNM 7th, histological type, tumor size, the number of regional lymph nodes examined, radiotherapy, chemotherapy and surgery were considered to be prognostic factors of OS. C-indexes of the established nomogram were 0.771 (95% CI (0.769, 0.773)) in the modeling group, which showed an ideal model discrimination ability. AUC and calibration plots of 3- and 5-year OS also proved the good performance of the established nomogram. The prognostic nomogram with reliable performance was developed to predict 3- and 5-year OS rates, which could assist clinicians to make more reasonable survival prediction for SPNSCLC patients. Conclusions: Age, sex, grade, marital status, AJCC TNM 7th, histological type, tumor size, the number of regional lymph nodes examined, radiotherapy, chemotherapy and surgery were considered to be prognostic factors of the second primary NSCLC. We developed a nomogram that can predict OS for patients with second primary NSCLC. This practical prognostic tool may help clinicians in treatment planning.