肺大细胞神经内分泌癌临床特征分析及预后模型建立

杨峤; 许子寒; 郑林鹏; 陈明镜; 余永新; 孙建国

doi:10.16016/j.1000-5404.201812070

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肺大细胞神经内分泌癌临床特征分析及预后模型建立

基础医学 | 更新时间：2026-01-09

- 肺大细胞神经内分泌癌临床特征分析及预后模型建立
- Clinical characteristics of pulmonary large cell neuroendocrine carcinoma and a nomogram model for predicting its prognosis
- 第三军医大学学报 2019年41卷第12期页码：1156-1160
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院全军肿瘤研究所
- 作者简介：
  
  [孙建国，E-mail：sunjg09@aliyun.com SUN Jianguo, E-mail: sunjg09@aliyun.com
- 基金信息：
  
  国家自然科学基金面上项目(81773245);国家自然科学基金面上项目(81672841);2018年度陆军军医大学临床医学科研人才培养计划(2018XLC1010)
- DOI：10.16016/j.1000-5404.201812070
  中图分类号： R181.23;R730.7;R734.2
- 收稿：2018-12-07，
  
  修回：2019-02-02，
  
  纸质出版：2019-06-30
- 稿件说明：
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杨峤, 许子寒, 郑林鹏, 等. 肺大细胞神经内分泌癌临床特征分析及预后模型建立[J]. 第三军医大学学报, 2019,41(12):1156-1160.

Qiao YANG, Zihan XU, Linpeng ZHENG, et al. Clinical characteristics of pulmonary large cell neuroendocrine carcinoma and a nomogram model for predicting its prognosis[J]. Journal of Third Military Medical University, 2019, 41(12): 1156-1160.
杨峤, 许子寒, 郑林鹏, 等. 肺大细胞神经内分泌癌临床特征分析及预后模型建立[J]. 第三军医大学学报, 2019,41(12):1156-1160. DOI： 10.16016/j.1000-5404.201812070.

Qiao YANG, Zihan XU, Linpeng ZHENG, et al. Clinical characteristics of pulmonary large cell neuroendocrine carcinoma and a nomogram model for predicting its prognosis[J]. Journal of Third Military Medical University, 2019, 41(12): 1156-1160. DOI： 10.16016/j.1000-5404.201812070.

摘要

目的

基于监测、流行病学和结果数据库(Surveillance

Epidemiology

and End Results，SEER)，分析肺大细胞神经内分泌癌(pulmonary large cell neuroendocrine carcinoma

PLCNEC)的临床特征和患者生存情况，建立预后模型。

方法

从SEER数据库中收集2004-2013年诊断为PLCNEC的患者1 656例，描述其基本临床特征，通过Kaplan-Meier法绘制生存曲线并进行生存分析。使用Cox比例风险模型探索与总生存期(overall survival，OS)相关的临床特征，并建立可视化的预测患者预后的列线图(nomogram)模型，通过重复抽样对模型进行验证。

结果

1 656例PLCNEC患者中，男性(55.37%)和诊断年龄≥65岁(52.05%)居多，以白种人(84.12%)为主；40.94%做过手术治疗，37.80%做过放疗，51.93%做过化疗。生存分析发现：患者中位生存期为11个月，1年生存率为46.5%。Cox比例风险模型多因素分析发现：女性、黑种人及其他种族、手术治疗、放疗及化疗为保护因素，而年龄≥65岁，肿瘤长径增大，肿瘤向邻近组织、区域淋巴结及远处扩散为危害因素，肿瘤部位对生存影响无明显差异。利用上述与OS相关的临床特征，建立可视化列线图模型，可通过基本临床特征来预测PLCNEC患者的1年生存率。重复抽样验证发现该模型1年生存率预测值与实际值一致性较好(C-index为0.76)。

结论

PLCNEC患者中位OS为11个月，1年生存率为46.5%；性别、诊断年龄、种族、基线肿瘤长径、肿瘤扩散、手术治疗、放射治疗及化疗等临床特征与PLCNEC生存预后相关；成功建立可视化列线图模型，可预测PLCNEC患者1年生存率。

Abstract

Objective

To analyze the clinical characteristics and survival of patients with pulmonary large cell neuroendocrine carcinoma (PLCNEC) and construct a nomogram model for predicting its prognosis.

Methods

We searched the Surveillance

Epidemiology

and End Results (SEER) database to collect the data of patients diagnosed with PLCNEC between 2004 and 2013. Kaplan-Meier method was used for survival analysis of the patients. A Cox proportional hazard model was used to identify the factors affecting the overall survival (OS)

and the significant factors were used to construct a nomogram model for predicting the patients' 1-year survival probability. The discrimination power of this model was assessed based on the C-index

and the calibration was evaluated with a bootstrap procedure.

Results

A total of 1 656 cases of PLCNEC with complete record of the clinical characteristics were collected. Of these patients

55.37% were male

52.05% were above 65 years of age at diagnosis

and 84.12% were white; 51.93% of the patients received chemotherapy

40.94% had surgeries

and 37.80% had radiotherapy. Kaplan-Meier survival analysis showed that the median OS of patients with PLCNEC was 11 months

and their 1-year survival rate was 46.5%. Multivariate analysis identified a female gender

black race

surgery

radiotherapy and chemotherapy as the protective factors

while an age ≥65 years

an increased tumor size

invasion of adjacent tissues

lymph node involvement and distant metastasis were the risk factors for poor prognosis; the primary tumor sites did not significantly affect the survival outcomes of the patients. We established a nomogram model for predicting the 1-year survival probability of the patients based on the significant factors identified in the multivariate analysis. The C-index of this prediction model was 0.76

and assessment of calibration showed that the 1-year survival rate predicted by this model was highly consistent with the observed 1-year survival rate of the patients.

Conclusion

According to the data from SEER

patients with PLCNEC have a median OS of 11 months and a 1-year survival rate of 46.5%. Gender

age

race

tumor size

tumor growth and metastasis and interventions are all associated with the OS of the patients. The nomogram model we established based on the clinical characteristics of PLCNEC is capable of predicting the 1-year survival probability of the patients.

关键词

Keywords

references

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