肺大细胞神经内分泌癌的预后影响因素:一项基于SEER数据库的研究

Prognostic factors in lung large-cell neuroendocrine carcinoma:an SEER database-based study

目的探讨肺大细胞神经内分泌癌(LCNEC)患者的生存预后及其影响因素。方法横断面研究。纳入监测、流行病学和最终结果数据库(SEER)2010年1月—2016年12月收录的2504例肺LCNEC患者,其中男1357例、女1147例,<60岁633例、60~80岁1664例、>80岁207例。采用Kaplan-Meier法计算患者生存率,Log-rank检验比较不同因素对患者生存率影响的差异;Cox比例风险模型进行多因素生存分析,确定肺LCNEC患者的预后影响因素。结果(1)2504例患者3年、5年累积总生存率分别为21.1%、16.0%,肿瘤特异性生存率分别为34.9%、30.8%。(2)单因素分析:患者年龄、性别、肿瘤部位、侧别、肿瘤分化程度、美国癌症联合委员会(AJCC)肺癌TNM 2017第八版分期、肿瘤大小T分期、区域淋巴结N分期、是否有远处转移,以及是否有骨、肝、脑转移,是否手术、是否化疗对患者的生存预后有影响(P值均<0.05)。有无保险、婚姻状况、人种、放疗与否对患者预后无影响(P值均>0.05)。(3)多因素分析:男性、左侧病灶、肺癌TNM八版AJCC较高分期、较大肿块、有区域淋巴结转移、有肝组织转移是患者生存预后的独立危险因素(P值均<0.05)。手术、化疗患者的死亡风险系数相较于未手术或化疗的患者明显降低(P值均<0.05)。(4)分层分析:在未发生转移的肺LCNEC患者,放疗与否其总生存和肿瘤特异性生存预后差异均无统计学意义(P值均>0.05);在发生转移的患者,与未放疗患者相比,放疗可以提高患者总生存率和肿瘤特异性生存率,差异均有统计学意义(χ^(2)=38.59、19.08,P值均<0.01)。结论LCNEC患者预后较差,总体生存率不高。手术、化疗可以有效延长患者总生存时间,降低死亡风险,是肺LCNEC预后的独立保护因素。对于未发生转移的患者,无法从放疗中获益;对于已经发生转移的患者,推荐使用放疗。

Objective This study aimed to investigate the prognostic factors and survival rate of lung large-cell neuroendocrine carcinoma(LCNEC).Methods The cross-sectional study was conducted.A total of 2504 patients with lung LCNEC from January 2010 to December 2016 were included in the Surveillance,Epidemiology,and End Results Database.Among them,1357 were male and 1147 were female,including 633 patients younger than 60 years old,1664 patients aged 60-80 years old,and 207 patients older than 80 years old.The survival rate of patients was calculated by the Kaplan-Meier method,and differences in the influence of different factors on survival rate were compared by Log-rank test.Cox proportional risk model for multifactor survival analysis was used to determine prognostic factors in patients with LCNEC.Results(1)The 3-and 5-year overall survival rates of 2504 patients were 21.1% and 16.0%,and tumor-specific survival rates were 34.9% and 30.8%,respectively.(2)Single-factor analysis showed that the following factors were correlated with the prognosis of patients:patient age,sex,tumor site,side,tumor differentiation,American Joint Committee on Cancer(AJCC)lung cancer TNM 2017 eighth edition stage,tumor size and stage,regional lymph-node stage,presence of distant metastasis,presence of bone,liver,or brain metastasis,whether surgery was conducted,and whether chemotherapy was administered(all P values<0.05).No significant correlation of prognosis with insurance,marital status,and race was observed(all P values>0.05).(3)Multiple-factor analysis demonstrated that the following were independent risk factors for survival and prognosis:male,left lesion,lung cancer with higher TNM AJCC staging,larger mass,regional lymph-node metastasis,and liver-tissue metastasis(all P values<0.05).The mortality risk coefficient of patients undergoing surgery or chemotherapy were significantly lower than that of patients without surgery or chemotherapy(all P values<0.05).(4)Stratification analysis revealed no significant difference in overall survival and tumor-specific survival prognosis among patients with lung LCNEC without metastasis(all P values>0.05).In patients with metastasis,compared with patients without radiotherapy,radiotherapy can improve the overall survival rate and tumor-specific survival rate,and the differences were statistically significant(χ^(2)=38.59,19.08;all P values<0.01).Conclusion The prognosis of the patients with LCNEC are poor and the overall survival rates are lower.Surgery and chemotherapy can effectively prolong the overall survival time of patients and reduce the risk of death,which are independent protective factors for LCNEC prognosis.Patients without metastasis cannot benefit from radiotherapy.For patients who have metastases,radiation therapy is recommended.