【摘要】 背景与目的 肺大细胞神经内分泌癌(lung large cell neuroendocrine carcinoma,LCNEC)是一种罕见且预后极差的肺恶性肿瘤。目前对LCNEC的研究大多基于回顾性研究,缺乏现实世界的验证。本研究旨在识别独立的危险因素,建立并验证LCNEC预后的预测模型。方法 从2010至2015年监测、流行病学和结果数据库(Surveillance,Epidemiology,and End Results,SEER)和我科2016至2020年住院患者中提取患者资料。采用Kaplan-Meier法评估总生存期(overall survival,OS)。OS被定义为患者从确诊到死亡或最后一次随访时间。单因素Cov回归分析和多因素Cox回归分析确定显著的预后因素。从而构建预测LCNEC预后的Nomogram。结果 共纳入1892例LCNEC患者,分为训练队列(n=1288)和两个验证队列(n=552,n=52)。单因素Cox回归分析显示年龄、性别、肿瘤原发部位、偏侧、肿瘤原发灶-淋巴结-转移(tumor-node-metastasis,TNM)各分期、手术、放疗可影响LCNEC的预后(P<0.05),多因素Cox分析显示年龄、性别、肿瘤原发部位、T分期、N分期、M分期、手术、放疗是LCNEC患者预后的独立危险因素(P<0.05)。校准曲线和一致性指数(内部:0.744±0.015;外部:0.763±0.020、0.832±0.055)显示模型预测性能良好。结论 年龄≥65岁、男性、TNM分期晚、未经过手术或放疗的患者预后不佳。列线图可以对患者的个性化临床决策提供一定的参考。更多还原

【Abstract】 Background and objective Lung large cell neuroendocrine carcinoma(LCNEC) is a rare and highly malignant lung tumor with a poor prognosis.Currently,most research on LCNEC is based on retrospective studies and lacks validation in the real world.The study aims to identify independent risk factors and establish and validate a predictive model for the prognosis of LCNEC.Methods Patient data were extracted from Surveillance,Epidemiology,and End Results(SEER) and our department’s hospitalization records from 2010 to 2015 and 2016 to 2020,respectively.Kaplan-Meier analysis was used to evaluate overall survival(OS).OS is defined as the time from diagnosis to death or last follow-up for a patient.Univariate and multivariate Cox regression analyses were performed to identify significant prognostic factors and construct a Nomogram for predicting the prognosis of LCNEC.Results In total,1892 LCNEC patients were included and divided into a training cohort(n=1288) and two validation cohorts(n=552,n=52).Univariate Cox regression analysis showed that age,gender,primary tumor site,laterality,T stage,N stage,M stage,surgery,and radiotherapy were factors that could affect the prognosis of LCNEC patients(P<0.0 5).Multivariate Cox analysis indicated that age,gender,primary tumor site,T stage,N stage,M stage,surgery,and radiotherapy were independent risk factors for the prognosis of LCNEC patients(P<0.05).Calibration curves and the concordance index(internal:0.744±0.01S;external:0.763±0.020,0.832±0.055) demonstrated good predictive performance of the model.Conclusion Patients aged ≥65 years,male,with advanced tumor-node-metastasis(TNM) staging,and who have not undergone surgery or radiotherapy have a poor prognosis.Nomogram can provide a certain reference for personalized clinical decision-making for patients.更多还原