手术对N2期肺大细胞神经内分泌癌的生存影响:一项基于SEER数据库的倾向性匹配分析  

Survival effects of surgery on N2 stage lung large cell neuroendocrine carcinoma: a propensity matching analysis via SEER database

作　　者：姚夏雷 李慧民 孙立红[2] Yao Xialei;Li Huimin;Sun Lihong(Department of Oncology,Liaocheng People's Hospital,Liaocheng 252000,China;Department of Respiratory and Critical Care Medicine,Liaocheng People's Hospital,Liaocheng 252000,China)

机构地区：[1]聊城市人民医院肿瘤内科,聊城252000 [2]聊城市人民医院呼吸与危重症医学科,聊城252000

出　　处：《国际呼吸杂志》2024年第7期792-800,共9页International Journal of Respiration

基　　金：聊城市重点研发计划政策引导类项目(2022YDSF23)。

摘　　要：目的基于SEER数据库分析手术治疗后T0~4N2M0期肺大细胞神经内分泌癌(pLCNEC)患者的预后。方法在SEER数据库中检索2000-2019年病理诊断明确为大细胞神经内分泌癌/复合型大细胞神经内分泌癌(8013/3),且原发部位为肺的病例,共5450例。最终纳入符合研究条件的T0~4N2M0期pLCNEC患者共600例。根据是否进行手术治疗分为非手术治疗组(386例)和手术治疗组(214例)。为减少人口学和临床特征基线差异对结果的影响,采用倾向评分匹配(PSM)分析对2组患者进行匹配,匹配因素包括性别、年龄、种族、手术、放疗、化疗、分期。比值为1,卡尺值为0.02。共匹配成功181对,其中精确匹配46对,模糊匹配135对。根据PSM后是否进行手术治疗分为手术组(181例)和非手术组(181例)。比较手术治疗组与非手术治疗组、手术组与非手术组患者的基线资料。采用Kaplan-Meier法绘制PSM后患者生存曲线,以及按T分期、放疗情况、化疗情况划分亚组的生存曲线,采用Log-rank检验进行比较。采用多因素Cox回归分析影响pLCNEC患者总生存期(OS)和肿瘤特异生存期(CSS)的因素。结果非手术治疗组中男197例,女189例,≥71岁的高龄患者较多(45.3%,175/386),T3~4N2M0期占大多数(58.3%,225/386),66.1%(255/386)的患者接受了放疗。手术治疗组中男123例,女91例,61~70岁患者较多(40.7%,87/214),T0~2 N2M0期占大多数(65.4%,140/214),43.9%(94/214)的患者接受了放疗。2组患者年龄、种族、放疗、T分期比较差异均有统计学意义(均P<0.05),性别和化疗比较差异均无统计学意义(均P>0.05)。PSM后,非手术组和手术组患者的基线特征比较差异均无统计学意义(均P>0.05)。PSM后,手术组中位OS为21个月(95%CI:16~26个月),非手术组中位OS为13个月(95%CI:10~16个月),手术组患者的生存状态优于非手术组患者的生存状态(χ^(2)=11.14,P<0.001)。多因素Cox回归分析显示男性、年龄≥71岁、黑人、T3~4期�Objective:To analyze the prognosis of patients with T0-4N2M0 stage pulmonary large cell neuroendocrine carcinomas(pLCNECs)who underwent surgical treatment by searching data in the Surveillance,Epidemiology,and End Results(SEER)database.Methods:Clinical data of 5,450 patients with pathologically confirmed large cell neuroendocrine carcinomas/compound large cell neuroendocrine carcinomas(8013/3)with the primary site of the lung were extracted from the SEER database between 2000 and 2019.A total of 600 eligible patients with T0-4N2M0 stage pLCNEC were finally included.They were assigned into the non-surgical group(386 cases)and surgical group(214 cases)based on the performance of surgery or not.In order to reduce the impact of the baseline differences in demographic and clinical characteristics on the results,propensity score matching(PSM)analysis was used to match the patients in the two groups,with the matching factors of gender,age,race,surgery,radiotherapy,chemotherapy,and tumor stage.At a PSM ratio of 1∶1,the match tolerance was set at 0.02.A total of 181 pairs were successfully matched,including 46 exact matches and 135 fuzzy matches.After matching,patients were assigned into the surgery group(181 cases)and the non-surgery group(181 cases)based on the performance of surgery or not.The baseline data of surgical group and non-surgical group,surgery group and non-surgery group were compared.The survival curves of the patients in the two groups after PSM,and those subdivided by T staging,radiotherapy,and chemotherapy were drawn using the Kaplan-Meier method,followed by the log-rank test for pairwise comparations.Multivariate Cox regression analysis was used to analyze the influencing factors for overall survival(OS)and cancer specific survival(CSS)of pLCNEC patients.Results:In the non-surgical group,there were 197 males and 189 females.Most of them in the non-surgical group was≥71 years(45.3%,175/386),and the majority was in T3-4N2M0 stage(58.3%,225/386).66.1%(255/386)patients received radiotherapy.In the surg

关 键 词：癌 神经内分泌 肺大细胞神经内分泌癌 倾向评分匹配分析 手术 总生存期 

分 类 号：R734.2[医药卫生—肿瘤]