Construction of a Prognostic Prediction Model of Patients with Pathologic N0 in Resected Invasive Mucinous Adenocarcinoma of the Lung

TL;DR

This paper develops a predictive model to assess the prognosis of lung invasive mucinous adenocarcinoma patients with no lymph node involvement after surgery.

Contribution

The novel contribution is the construction and validation of a prognostic nomogram for lymph node-negative IMA patients.

Findings

Imaging type, tumor size, and mucin content are independent prognostic factors for survival in IMA patients.

The nomogram achieved good predictive performance with C-indexes of 0.815 for PFS and 0.767 for OS.

Pneumonic and mixed-type IMA patients had significantly worse 5-year survival rates than isolated or pure mucinous types.

Abstract

背景与目的 肺浸润性黏液腺癌（invasive mucinous adenocarcinoma of the lung, IMA）是肺腺癌中一种少见且特殊的类型，该类肿瘤的特点往往是少有淋巴结转移，因此对于该类肿瘤的预后评估依靠现有的肿瘤原发灶-淋巴结-转移（tumor-node-metastasis, TNM）分期存在困难。本研究的目的是构建列线图来预测术后淋巴结阴性的IMA患者的预后。 方法 根据纳入标准和排除标准，回顾性分析2012年7月至2017年5月宁波大学附属李惠利医院（训练队列，n=78）和宁波市第二医院（验证队列，n=66）胸外科收治的术后病理为淋巴结阴性的IMA患者的资料，分析训练队列的临床病理特征的预后价值并建立预后预测模型，并对模型性能进行评价，最后将验证队列的数据代入进行外部验证。 结果 单因素分析显示肺炎型、较大的肿块、包含黏液和非黏液成分的混合型、较高的总分期是5年无进展生存期（progression-free survival, PFS）及总生存期（overall survival, OS）的影响因素。多因素分析进一步表明，影像学分型、肿块大小、黏液成分是5年PFS及OS的独立预后因素。5年PFS率和OS率分别为62.82%和75.64%，亚组的生存分析显示，肺炎型和包含黏液和非黏液成分的混合型IMA患者的5年PFS及OS分别明显低于孤立型和纯黏液型IMA患者。5年PFS和OS的Harrell’s C指数分别为0.815（95%CI: 0.741-0.889）和0.767（95%CI: 0.669-0.865），这两个模型的校准曲线及决策曲线分析（decision curve analysis, DCA）在两个队列中显示出良好的预测性能。 结论 本次基于临床病理特征构建的列线图在一定程度上可以作为IMA切除术后淋巴结阴性患者的一种有效预后预测工具。

Univariate analysis of clinicopathologic features of 78 patients with IMA

A: 5-year PFS; B: 5-year OS.

Multivariate analysis of clinicopathologic features of 78 patients with IMA

A: 5-year PFS; B: 5-year OS.

Training cohort: the calibration curves (A) and DCA curve (B) for predicting 5-year PFS of patients with IMA; Validation cohort: the calibration curves (C) and DCA curve (D) for predicting 5-year PFS of patients with IMA. Training cohort: the calibration curves (E) and DCA curve (F) for predicting 5-year OS of patients with IMA; Validation cohort: the calibration curves (G) and DCA curve (H) for predicting 5-year OS of patients with IMA. DCA: decision curve analysis.

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