10212例原发性肺癌患者临床流行病学特征及预测模型构建  

Clinical epidemiological distribution characteristics in 10212 primary lung cancer patients and construction of prediction model

作　　者：王菁[1] 李杰[1] 李晓敏[1] 李红卫[1] 李宁 WANG Jing;LI Jie;LI Xiaomin;LI Hongwei;LI Ning(Department of Radiation Oncology,Shanri Province Cancer Hospital/Shanri Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan,Shanxi 030013,China)

机构地区：[1]山西省肿瘤医院·中国医学科学院肿瘤医院山西医院·山西医科大学附属肿瘤医院放射治疗科,山西太原030013

出　　处：《中华肿瘤防治杂志》2024年第22期1354-1360,共7页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的分析山西省肿瘤医院收治的原发性肺癌患者临床流行病学特征,建立预后预测模型,为原发性肺癌的临床研究和防治提供一定的科学依据。方法收集山西省肿瘤医院2017-2021年收治的原发性肺癌患者性别、年龄、病理分型和临床分期相关资料。利用Cox比例风险回归分析预后相关因素,构建预后预测列线图模型。通过一致性指数、校准曲线和决策曲线(DCA)来评估列线图模型的性能。结果共纳入原发性肺癌患者10212例,2017-2021年依次为1361、1939、2148、2170和2594例。2021年患病人数是2017年的1.91倍;男女患病构成比由2017年的1.20∶1变化为2021年的2.51∶1,男性患者呈现增加趋势,χ^(2)=171.200,P<0.001;青年组、中年组和老年组患者占比分别从2017年的4.19%,38.50%和57.31%,变化到2021年的3.05%,33.89%和63.07%,H=13.331,P<0.001。中年组和老年组患病比例始终高于青年组。腺癌比例从2018年起逐年上升,由42.86%增加到2021年的53.66%;小细胞肺癌比例从2018年起逐年下降,由28.83%下降至2021年的17.35%,χ^(2)=204.300,P<0.001。腺癌、鳞癌和小细胞肺癌仍居原发性肺癌病理分型前3位;男性患者在鳞癌和小细胞肺癌中占比较高,分别是35.20%和22.04%,而女性患者在腺癌中占比较高,为72.24%,χ^(2)=1060.000,P<0.001。Ⅰ、Ⅱ、Ⅲ、Ⅳ期原发性肺癌构成比分别从2017年的15.50%、15.72%、34.90%和33.87%,变化至2021年的34.00%、9.68%、26.87%和29.45%;5年间Ⅰ期肺癌比例逐年上升,到2021年已位居第一位;Ⅳ期比例呈下降趋势,χ^(2)=327.300,P<0.001。2017-2021年Ⅰ~Ⅲ期原发性肺癌患者手术比例在前三年呈稳定趋势,自2020年起呈递增趋势,χ^(2)=50.961,P<0.001。Cox多因素分析显示,性别(HR=0.73,95%CI:0.68~0.78,P<0.001)、年龄(45~59岁vs≤44岁:HR=1.22,95%CI:1.03~1.44,P=0.023;≥60岁vs≤44岁:HR=1.42,95%CI:1.21~1.68,P=0.001),病理分型(鳞癌vs腺癌,HR=1.30,95%CI:1.20~1.40,P<0.001;小细胞癌vs腺癌,Objective To comprehend the evolving clinical and epidemiological characteristics of primary lung cancer pa-tients over time in Shanxi Province,establishing a prognosis prediction model aimed at offering scientific basis for the clin-ical research and prevention of primary lung cancer.Methods Data encompassing gender,age,pathological type,and clinical stage of primary lung cancer patients admitted to Shanxi Cancer Hospital from 2017 to 2021 were collected and an-alyzed.Cox proportional risk regression was used to analyze prognostic risk factors and to construct a prognosis prediction nomogram model.The performance of the nomogram model was assessed by using the concordance index,calibration curve,and decision curve analysis.Results A total of 10212 patients with primary lung cancer were included in the study.The annual distribution of patients was as follows:1361 in 2017,1939 in 2018,2148 in 2019,2170 in 2020,and 2594 in 2021.The number of cases in 2021 was 1.91 times that of 2017.The male-to-female ratio shifted signifi-cantly from 1.20:1 in 2017 to 2.51:1 in 2021,male showed an increasing trend,x2=171.200,P<0.001.The distri-bution of patients across different age groups changed from 4.19%young,38.5%middle-aged,and 57.31%elderly in 2017 to 3.05%young,33.89%middle-aged,and 63.07%elderly in 2021.The incidence rate in the middle-aged and eld-erly groups surpassed that in the young group,H=13.331,P<0.001.Adenocarcinoma proportions increased,from 42.86%in 2018 to 53.66%in 2021,while small cell lung cancer proportions decreased yearly since 2018,from 28.83%to 17.35%in 2021,x2=204.300,P<0.001.Adenocarcinoma,squamous cell carcinoma and small cell carcinoma were still the top 3.Squamous cell carcinoma and small cell carcinoma were more prevalent in male patients,35.20%and 22.04%,whereas adenocarcinoma was more common in females,72.24%,x2=1060.000,P<0.001.The proportions of stageⅠ,Ⅱ,ⅢandⅣof primary lung cancer verified from 15.50%,15.72%,34.90%and 33.87%in 2017 to 34.00%,9.68%,26.87%and 29.45%in 2021,separately.Th

关 键 词：原发性肺癌 性别 年龄 病理分型 TNM分期 山西省 

分 类 号：R734.2[医药卫生—肿瘤]