小细胞肺癌预后影响因素分析及列线图建立  

Analysis of prognostic factors and establishment of nomogram for small cell lung cancer

作　　者：刘琼婷 陈雪贞 朱金秀 肖仁栋[4] 林梦心[5] 何文辉 何斐[1] LIU Qiongting;CHEN Xuezhen;ZHU Jinxiu;XIAO Rendong;LIN Mengxin;HE Wenhui;HE Fei(The School of Public Health,Fujian Medical University,Fuzhou,Fujian 350108,China;Minjiang Teachers College,Fuzhou,Fujian 350100,China;Fuzhou Pulmonary Hospital,Fuzhou,Fujian 350000,China;The First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350000,China;Fujian Medical University Union Hospital,Fuzhou,Fujian 350000,China;Fuqing City Center for Disease Control and Prevention,Fuzhou,Fujian 350300,China)

机构地区：[1]福建医科大学公共卫生学院,福建福州350108 [2]闽江师范高等专科学校,福建福州350100 [3]福建省福州肺科医院,福建福州350000 [4]福建医科大学附属第一医院,福建福州350000 [5]福建医科大学附属协和医院,福建福州350000 [6]福清市疾病预防控制中心,福建福州350300

出　　处：《中华肿瘤防治杂志》2024年第21期1316-1325,共10页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的分析影响小细胞肺癌(SCLC)的预后因素,并建立预测模型。方法回顾性分析2017-06-17-2023-06-23福建医科大学附属第一医院(67例)、福建医科大学附属协和医院(92例)及福州肺科医院(157例)收治的共316例SCLC患者临床资料,包括患者临床病理特征和血液学检测指标。根据美国退伍军人管理局肺癌研究组(VALG)二期分期法将患者分为广泛期(261例)和局限期(55例);根据时间依赖受试者工作特征(ROC)曲线对血液学指标进行高、低水平分析。多因素Cox回归分析影响SCLC预后的危险因素并建立列线图;采用一致性指数(C-index)及校准曲线对模型进行评价;采用决策曲线分析法(DCA)评估模型的临床效益。结果广泛期(HR=1.418,95%CI:1.011~1.990,P=0.043)、治疗前乳酸脱氢酶(LDH)≥221.00 U/L(HR=1.332,95%CI:1.021~1.737,P=0.035)和治疗前胃泌素释放肽前体(ProGRP)≥591.90 ng/L(HR=1.416,95%CI:1.099~1.824,P=0.007)是SCLC患者无进展生存期(PFS)的独立危险因素。广泛期(HR=1.545,95%CI:1.062~2.247,P=0.023)、LDH≥221.00 U/L(HR=1.385,95%CI:1.044~1.838,P=0.024)、ProGRP≥591.90 ng/L(HR=1.412,95%CI:1.081~1.846,P=0.011)、治疗前D-二聚体≥1.48 mg/L(HR=1.750,95%CI:1.217~2.515,P=0.003)、一线化疗周期<4(HR=1.627,95%CI:1.239~2.138,P=0.001)及脑转移(HR=1.837,95%CI:1.169~2.887,P=0.008)是SCLC患者总生存期(OS)的独立危险因素。PFS与OS模型C-index分别为0.626(95%CI:0.589~0.663)和0.674(95%CI:0.639~0.709);1年和2年PFS与OS校准曲线均显示观测值与实际值较好的一致性,DCA曲线显示预测模型均具有良好的临床效益。结论基于分期、LDH及ProGRP等因素构建的PFS模型以及基于分期、一线化疗周期数、脑转移、LDH、ProGRP、D-二聚体等因素构建的OS模型在SCLC患者预后预测中具有较好的效果和临床应用价值。Objective To analyze the prognostic factors of small cell lung cancer(SCLC)and establish a prediction model.Methods Clinical data of 316 patients with SCLC admitted to the First Affiliated Hospital of Fujian Medical University(67 cases),Union Hospital Affiliated to Fujian Medical University(92 cases)and Fuzhou Pulmonary Hospital(157 cases)from June 17,2017,to June 23,2023 were retrospectively analyzed,including clinicopathological features and hematological indicators.According to the Veterans Administration Lung Cancer Study Group(VALG)phaseⅡstaging method,patients were divided into extensive stage(261 cases)and limited stage(55 cases).Hematological indicators were analyzed at high and low levels based on time-dependent receiver operating characteristic(ROC)curves.Multivariate Cox regression analysis was performed to analyze the risk factors affecting the prognosis of SCLC and to establish a nomogram.The consistency index(C-index)and calibration curve were used to evaluate the model.Decision curve analysis(DCA)was used to evaluate the clinical benefit of the model.Results Extensive stage(HR=1.418,95%CI:1.011-1.990,P-0.043),pre-treatmeit lactate dehydrogenase(LDH)≥221.00 U/L(HR=1.332,95%CI:1.021-1.737,P=0.035),and pre-treatment progastrin-releasing peptide(ProGRP)≥591.90 ng/L(HR=1.416,95%CI:1.099-1.824,P=0.007)were independent risk factors for progression-free survival(PFS)in SCLC patients.Extensive stage(HR=1.545,95%CI:1.062-2.247,P=0.023),LDH≥221.00 U/L(HR=1.385,95%CI:1.044-1.838,P=0.024),ProGRP≥591.90 ng/L(HR=1.412,95%CI:1.081-1.846,P=0.011),D-dimer≥1.48 mg/L before treatment(HR=1.750,95%CI:1.217-2.515,P=0.003),first-line chemotherapy cycles<4(HR=1.627,95%CI:1.239-2.138,P=0.001)and brain metastases(HR=1.837,95%CI:1.169-2.887,P=0.008)were independent risk factors for overall survival(OS)in SCLC patients.The C-index of PFS and OS models were 0.626(95%CI:0.589-0.663)and 0.674(95%CI:0.639-0.709),respectively.The 1-year and 2-year PFS and OS calibration curves showed good agreement between the observed

关 键 词：小细胞肺癌 预后 列线图 血液学标志物 

分 类 号：R734.2[医药卫生—肿瘤]