肺内和肺外小细胞癌基本临床特征的比较

Comparative analysis of basic clinical features of intrapulmonary and extrapulmonary small cell carcinoma

目的 收集小细胞癌患者的病例资料,包括性别、年龄、种族、肿瘤原发部位、分期及生存时间,比较并分析小细胞肺癌(small cell lung cancer,SCLC)与肺外小细胞癌(extrapulmonary small cell carcinoma,EPSCC)患者的病例特征及生存预后差异,以期更好地了解SCLC和EPSCC临床基本特征。方法 通过SEER stat软件提取美国国立癌症研究所(National Cancer Institute,NCI)的监测、流行病学和最终结果(surveillance,epidemiology and end results,SEER)数据库1975-2016年112 415例经病理学诊断为小细胞癌患者的病例信息,包括性别、年龄、种族、肿瘤原发部位、分期和生存时间。分类变量用例(%)描述,卡方检验分析分类变量间的相关性。Kaplan-Meier法计算5年生存率及中位生存时间。单变量与多变量Cox回归分析影响生存相关的因素。结果 共收集112 415例小细胞癌患者,其中SCLC和EPSCC分别为107165例(95.3%)和5 250例(4.7%)。在肺外小细胞癌中,以泌尿和消化系统小细胞癌占比最多,分别为1.5%和1.4%。生存分析表明EPSCC的5年生存率远高于SCLC(P <0.001),其中头颈部小细胞癌的5年生存率最高,达28.6%;其次为子宫、卵巢的小细胞癌,为27%和26%;而原发于胰腺、阑尾和肝脏的5年生存率较低,分别为4.3%、0和0。Cox回归分析表明,性别、年龄、种族、肿瘤原发部位及是否接受手术和(或)放化疗为影响预后的因素(P <0.05)。结论 肺内小细胞癌患者数量远高于肺外小细胞癌患者(95.3%vs. 4.7%),但其5年生存率远低于EPSCC(5.4%vs. 17.1%);在EPSCC患者中,原发于头颈部的小细胞癌5年生存率最高,为28.6%,而原发于肝脏和阑尾的小细胞癌的5年生存率最低,为0且低于SCLC的5年生存率(5.4%)。

Objective Collect case data of patients with small cell carcinoma,including Sex,age,ethnicity,tumor primary site,stage,and survival time,compare and analyze the differences in case characteristics and survival outcomes betweenSCLC andEPSCC to better understand the basic clinical features of thetwo groups.Methods SEER stat software was used to extract SEER database of 112415 cases of small cell carcinoma from 1975 to 2016,including sex,age,ethnicity,tumor primary site,Staging and survival time.Categorical variables are described by n(%),Chi⁃square test analyzes the correlation between categorical variables.The Kaplan⁃Meier method calculated 5⁃year survival and median survival.Univariate and multivariate COX regression analysis affects factors related to survival.Results A total of112415 patients with small cell carcinoma were collected,including 107165(95.3%)in the lung and 5250(4.7%)in the extrapulmonary area.Among the EPSCC,the primary ones in the urinary system and digestive system accounted for the largest proportion,accounting for 1.5%and 1.4%.Survival analysis showed that the 5⁃year survival rate of EPSCC was much higher than SCLC(P<0.001),Among EPSCC,the 5⁃year survival rate of head and neck small cell carcinoma was the highest,reaching 28.6%;followed by uterusandovaries with 27%and 26%;respectively,and the lowest in pancreas,appendix and liver at only 4.3%,0%and 0%.COX multivariate regression analysis showed that sex,age,ethnicity,primary site of tumor and whether surgery and/or chemoradiotherapy were all important factors of survival(P<0.05).Conclusion The number of patients with SCLC was much higher than that of patients with EPSCC(95.3%vs 4.7%),but SCLC had a lower 5⁃year survival rate than EPSCC(5.4%vs 17.1%).In patients with EPSCC,small cell carcinoma primary in the head and neck had the highest 5⁃year survival rate(28.6%),while 5⁃year survival was lowest for the liver and appendix(0%),even lower than SCLC(5.4%).