2010年-2015年SEER数据库肺腺鳞癌患者临床特征及预后分析
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摘要
背景与目的肺癌发病率和死亡率均位居所有恶性肿瘤的第一,严重影响人类健康。非小细胞肺癌(non-small cell lung cancer,NSCLC)中常见病理类型为腺癌和鳞癌,临床研究和关注较多,而肺腺鳞癌是一种较为罕见的肺癌病理类型,其临床特征及预后相关因素尚未完全明确。本研究即对肺腺鳞癌的临床特征及预后进行分析,并构建了列线图来预测患者的预后。方法我们纳入了2010年-2015年美国SEER(Surveillance,Epidemiology,and End Results)数据库中的肺腺鳞癌数据,与同期的肺腺癌和肺鳞癌的临床特征和预后进行了比较。随后我们采用单因素和多因素分析研究了肺腺鳞癌患者预后的独立相关因素,以此构建了列线图并进行了验证。结果我们一共入组了肺腺鳞癌患者1,453例。与同期的肺腺癌和肺鳞癌患者相比较,肺腺鳞癌患者在大多数变量中的分布情况均介于肺腺癌和鳞癌之间,其预后也优于肺鳞癌但差于肺腺癌患者。多因素分析发现,年龄、分化程度、肿瘤-淋巴结-转移(tumor-node-metastasis,TNM)、手术和化疗是患者预后的独立影响因素(P均<0.001)。我们以此构建了列线图,其C-index为0.783(0.767-0.799),区分度检验和一致性检验均表明这一列线图可以有效地预测患者预后。结论肺腺鳞癌具有独特的临床病理和预后特征。年龄、分化、T、N、M、手术和化疗状况是肺腺鳞癌患者预后的独立预测因素。我们以此构建的列线图可以较好地预测患者预后。
Background and objective The incidence and the mortality of lung cancer rank first among all malignant tumors and it seriously affects human health. The common types of non-small cell lung cancer(NSCLC) are adenocarcinoma and squamous carcinoma with clinical research and more attention, while adenosquamous carcinoma is a rare pathological subtype of lung cancer, which clinical features and prognostic factors are not yet fully understood. The purpose of this study is to analyze the clinical features and prognosis of lung adenosquamous carcinoma, and construct a nomogram to predict the patients' prognosis. Methods We obtained the data of adenosquamous carcinoma patients diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results(SEER) database of the United States, and compared their clinical features and prognosis with those of lung adenocarcinoma and lung squamous cell carcinoma patients in the same period. Then we used univariate and multivariate analyses to explore the independent prognostic factors of adenosquamous carcinoma. Finally, we constructed and validated a nomogram to visually predict the outcomes of lung adenosquamous carcinoma. Results 1,453 patients with lung adenosquamous carcinoma were finally included. Compared with patients with lung adenocarcinoma and lung squamous cell carcinoma, the distributions of lung adenocarcinoma patients in most of the variables were medium between lung adenocarcinoma and squamous cell carcinoma. The prognosis of adenosquamous carcinoma was better than that of lung squamous cell carcinoma, but worse than that of lung adenocarcinoma. Multivariate analysis showed that age, differentiation, tumornode-metastasis(TNM), surgery, and chemotherapy were independent prognostic factors(all P were less than 0.001). We constructed a nomogram with a C-index of 0.783(0.767-0.799). The distinction test and consistency test showed that the nomogram could predict the patient's prognosis effectively. Conclusion Lung adenosquamous carcinoma has unique clinical, pathological, and prognostic characteristics. Age, differentiation, T, N, M, surgery, and chemotherapy status are independent predictors of prognosis in patients with adenosquamous carcinoma. Our nomogram can efficiently predict the prognosis of patients..
Background and objective The incidence and the mortality of lung cancer rank first among all malignant tumors and it seriously affects human health. The common types of non-small cell lung cancer(NSCLC) are adenocarcinoma and squamous carcinoma with clinical research and more attention, while adenosquamous carcinoma is a rare pathological subtype of lung cancer, which clinical features and prognostic factors are not yet fully understood. The purpose of this study is to analyze the clinical features and prognosis of lung adenosquamous carcinoma, and construct a nomogram to predict the patients' prognosis. Methods We obtained the data of adenosquamous carcinoma patients diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results(SEER) database of the United States, and compared their clinical features and prognosis with those of lung adenocarcinoma and lung squamous cell carcinoma patients in the same period. Then we used univariate and multivariate analyses to explore the independent prognostic factors of adenosquamous carcinoma. Finally, we constructed and validated a nomogram to visually predict the outcomes of lung adenosquamous carcinoma. Results 1,453 patients with lung adenosquamous carcinoma were finally included. Compared with patients with lung adenocarcinoma and lung squamous cell carcinoma, the distributions of lung adenocarcinoma patients in most of the variables were medium between lung adenocarcinoma and squamous cell carcinoma. The prognosis of adenosquamous carcinoma was better than that of lung squamous cell carcinoma, but worse than that of lung adenocarcinoma. Multivariate analysis showed that age, differentiation, tumornode-metastasis(TNM), surgery, and chemotherapy were independent prognostic factors(all P were less than 0.001). We constructed a nomogram with a C-index of 0.783(0.767-0.799). The distinction test and consistency test showed that the nomogram could predict the patient's prognosis effectively. Conclusion Lung adenosquamous carcinoma has unique clinical, pathological, and prognostic characteristics. Age, differentiation, T, N, M, surgery, and chemotherapy status are independent predictors of prognosis in patients with adenosquamous carcinoma. Our nomogram can efficiently predict the prognosis of patients..
引文
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2 Allemani C,Matsuda T,Di Carlo V,et al.Global surveillance of trends in cancer survival 2000-14(CONCORD-3):analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322population-based registries in 71 countries.Lancet,2018.doi:10.1016/S0140-6736(17)33326-3
3 Shimoji M,Nakajima T,Yamatani C,et al.A clinicopathological and immunohistological re-evaluation of adenosquamous carcinoma of the lung.Pathol Int,2011,61(12):717-722.doi:10.1111/j.1440-1827.2011.02730.x
4 Zhu L,Jiang L,Yang J,et al.Clinical characteristics and prognosis of patients with lung adenosquamous carcinoma after surgical resection:results from two institutes.J Thorac Dis,2018,10(4):2397-2402.doi:10.21037/jtd.2018.03.186
5 Zhao WJ,Wang X,Ma KW,et al.Progression of diagnosis and treatment of adenosquamous lung cancer.Zhonghua Zhong Liu Za Zhi,2017,39(4):241-244.[赵文君,王旭,马克威.肺腺鳞癌研究进展.中华肿瘤杂志,2017,39(4):241-244.]doi:10.3760/cma.j.issn.0253-3766.2017.04.00
6 Travis WD,Brambilla E,Noguchi M,et al.International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma.JThorac Oncol,2011,6(2):244-285.doi:10.1097/JTO.0b013e318206a221
7 Travis WD,Brambilla E,Burke AP,et al.Introduction to The 2015 World Health Organization Classification of Tumors of the Lung,Pleura,Thymus,and Heart.J Thorac Oncol.2015,10(9):1240-1242.doi:10.1097/JTO.0000000000000663
8 Wang S,Ma K,Chen Z,et al.A nomogram to predict prognosis in malignant pleural mesothelioma.World J Surg,2018,42(7):2134-2142.doi:10.1007/s00268-017-4424-6
9 Sun F,Ma K,Yang X,et al.A nomogram to predict prognosis after surgery in early stage non-small cell lung cancer in elderly patients.Int J Surg,2017,42:11-16.doi:10.1016/j.ijsu.2017.04.024
10 Maeda H,Matsumura A,Kawabata T,et al.Adenosquamous carcinoma of the lung:surgical results as compared w ith squamous cel l and adenocarcinoma cases.Eur J Cardiothorac Surg,2012,41(2):357-361.doi:10.1016/j.ejcts.2011.05.050
11 Filosso PL,Ruffini E,Asioli S,et al.Adenosquamous lung carcinomas:a histologic subtype with poor prognosis.Lung Cancer,2011,74(1):25-29.doi:10.1016/j.lungcan.2011.01.030
12 Gawrychowski J,Brulinski K,Malinowski E,et al.Prognosis and survival after radical resection of primary adenosquamous lung carcinoma.Eur JCardiothorac Surg,2005,27(4):686-692.doi:10.1016/j.ejcts.2004.12.030
13 Wang J,Lian B,Ye L,et al.Clinicopathological characteristics and survival outcomes in adenosquamous carcinoma of the lung:a population-based study from the SEER database.Oncotarget,2018,9(8):8133-8146.doi:10.18632/oncotarget.23550
14 Jiang NY,Pan HM,Li D.Research progression of lung adenosquamous carcinoma.Ai Zheng Jin Zhan,2017,15(4):345-348.[姜南宇,潘宏铭,李达.肺腺鳞癌的研究进展.癌症进展,2017,15(4):345-348.]doi:10.11877/j.issn.1672-1535.2017.15.04.01
15 Powrozek T,Krawczyk P,Ramlau R,et al.EGFR gene mutations in patients with adenosquamous lung carcinoma.Asia Pac J Clin Oncol,2014,10(4):340-345.doi:10.1111/ajco.12177
16 Shiozawa T,Ishii G,Goto K,et al.Clinicopathological characteristics of EGFR mutated adenosquamous carcinoma of the lung.Pathol Int,2013,63(2):77-84.doi:10.1111/pin.12033
17 Vassella E,Langsch S,Dettmer MS,et al.Molecular profiling of lung adenosquamous carcinoma:hybrid or genuine type?Oncotarget,2015,6(27):23905-23916.doi:10.18632/oncotarget.4163
18 Liu Y,Dong Z,Jiang T,et al.Heterogeneity of PD-L1 expression among the different histological components and metastatic lymph nodes in patients with resected lung adenosquamous carcinoma.Clin Lung Cancer,2018,19(4):e421-e430.doi:10.1016/j.cllc.2018.02.008
19 Yang X,Zhan C,Li M,et al.Lobectomy versus sublobectomy in metachronous second primary lung cancer:a propensity-score study.Ann Thorac Surg,2018.doi:10.1016/j.athoracsur.2018.04.071
20 Yang X,Sun F,Chen L,et al.Prognostic value of visceral pleural invasion in non-small cell lung cancer:A propensity score matching study based on the SEER registry.J Surg Oncol,2017,116(3):398-406.doi:10.1002/jso.24677
2 Allemani C,Matsuda T,Di Carlo V,et al.Global surveillance of trends in cancer survival 2000-14(CONCORD-3):analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322population-based registries in 71 countries.Lancet,2018.doi:10.1016/S0140-6736(17)33326-3
3 Shimoji M,Nakajima T,Yamatani C,et al.A clinicopathological and immunohistological re-evaluation of adenosquamous carcinoma of the lung.Pathol Int,2011,61(12):717-722.doi:10.1111/j.1440-1827.2011.02730.x
4 Zhu L,Jiang L,Yang J,et al.Clinical characteristics and prognosis of patients with lung adenosquamous carcinoma after surgical resection:results from two institutes.J Thorac Dis,2018,10(4):2397-2402.doi:10.21037/jtd.2018.03.186
5 Zhao WJ,Wang X,Ma KW,et al.Progression of diagnosis and treatment of adenosquamous lung cancer.Zhonghua Zhong Liu Za Zhi,2017,39(4):241-244.[赵文君,王旭,马克威.肺腺鳞癌研究进展.中华肿瘤杂志,2017,39(4):241-244.]doi:10.3760/cma.j.issn.0253-3766.2017.04.00
6 Travis WD,Brambilla E,Noguchi M,et al.International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma.JThorac Oncol,2011,6(2):244-285.doi:10.1097/JTO.0b013e318206a221
7 Travis WD,Brambilla E,Burke AP,et al.Introduction to The 2015 World Health Organization Classification of Tumors of the Lung,Pleura,Thymus,and Heart.J Thorac Oncol.2015,10(9):1240-1242.doi:10.1097/JTO.0000000000000663
8 Wang S,Ma K,Chen Z,et al.A nomogram to predict prognosis in malignant pleural mesothelioma.World J Surg,2018,42(7):2134-2142.doi:10.1007/s00268-017-4424-6
9 Sun F,Ma K,Yang X,et al.A nomogram to predict prognosis after surgery in early stage non-small cell lung cancer in elderly patients.Int J Surg,2017,42:11-16.doi:10.1016/j.ijsu.2017.04.024
10 Maeda H,Matsumura A,Kawabata T,et al.Adenosquamous carcinoma of the lung:surgical results as compared w ith squamous cel l and adenocarcinoma cases.Eur J Cardiothorac Surg,2012,41(2):357-361.doi:10.1016/j.ejcts.2011.05.050
11 Filosso PL,Ruffini E,Asioli S,et al.Adenosquamous lung carcinomas:a histologic subtype with poor prognosis.Lung Cancer,2011,74(1):25-29.doi:10.1016/j.lungcan.2011.01.030
12 Gawrychowski J,Brulinski K,Malinowski E,et al.Prognosis and survival after radical resection of primary adenosquamous lung carcinoma.Eur JCardiothorac Surg,2005,27(4):686-692.doi:10.1016/j.ejcts.2004.12.030
13 Wang J,Lian B,Ye L,et al.Clinicopathological characteristics and survival outcomes in adenosquamous carcinoma of the lung:a population-based study from the SEER database.Oncotarget,2018,9(8):8133-8146.doi:10.18632/oncotarget.23550
14 Jiang NY,Pan HM,Li D.Research progression of lung adenosquamous carcinoma.Ai Zheng Jin Zhan,2017,15(4):345-348.[姜南宇,潘宏铭,李达.肺腺鳞癌的研究进展.癌症进展,2017,15(4):345-348.]doi:10.11877/j.issn.1672-1535.2017.15.04.01
15 Powrozek T,Krawczyk P,Ramlau R,et al.EGFR gene mutations in patients with adenosquamous lung carcinoma.Asia Pac J Clin Oncol,2014,10(4):340-345.doi:10.1111/ajco.12177
16 Shiozawa T,Ishii G,Goto K,et al.Clinicopathological characteristics of EGFR mutated adenosquamous carcinoma of the lung.Pathol Int,2013,63(2):77-84.doi:10.1111/pin.12033
17 Vassella E,Langsch S,Dettmer MS,et al.Molecular profiling of lung adenosquamous carcinoma:hybrid or genuine type?Oncotarget,2015,6(27):23905-23916.doi:10.18632/oncotarget.4163
18 Liu Y,Dong Z,Jiang T,et al.Heterogeneity of PD-L1 expression among the different histological components and metastatic lymph nodes in patients with resected lung adenosquamous carcinoma.Clin Lung Cancer,2018,19(4):e421-e430.doi:10.1016/j.cllc.2018.02.008
19 Yang X,Zhan C,Li M,et al.Lobectomy versus sublobectomy in metachronous second primary lung cancer:a propensity-score study.Ann Thorac Surg,2018.doi:10.1016/j.athoracsur.2018.04.071
20 Yang X,Sun F,Chen L,et al.Prognostic value of visceral pleural invasion in non-small cell lung cancer:A propensity score matching study based on the SEER registry.J Surg Oncol,2017,116(3):398-406.doi:10.1002/jso.24677