Article(id=1198558166339388087, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198558165093675863, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1133.2024.0327, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1692806400000, receivedDateStr=2023-08-24, revisedDate=null, revisedDateStr=null, acceptedDate=1697040000000, acceptedDateStr=2023-10-12, onlineDate=1763688134988, onlineDateStr=2025-11-21, pubDate=1724774400000, pubDateStr=2024-08-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763688134988, onlineIssueDateStr=2025-11-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763688134988, creator=13701087609, updateTime=1763688134988, updator=13701087609, issue=Issue{id=1198558165093675863, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='8', pageStart='855', pageEnd='976', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763688134691, creator=13701087609, updateTime=1763689174168, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1198562525043327039, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198558165093675863, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1198562525043327040, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198558165093675863, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=889, endPage=896, ext={EN=ArticleExt(id=1198558167044031163, articleId=1198558166339388087, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Construction of prognosis prediction and risk stratification model for young patients with advanced lung adenocarcinoma based on SEER database, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective Based on data from the US SEER database, this study investigates the incidence, epidemiological characteristics, treatment modalities, prognosis assessment, and risk stratification of advanced-stage lung adenocarcinoma in young patients. Methods SEER*Stat software was used to collect the incidence rates of lung adenocarcinoma among people under 50 in the US from 2000 to 2020, with annual percentage changes (APCs) calculated using Joinpoint software. Clinical data of 4490 advanced-stage lung adenocarcinoma patients under 50 years old from the SEER database (2010-2018) were retrospectively collected and analyzed. Kaplan-Meier method was used to calculate overall survival, log-rank test to estimate survival rates, and Cox proportional hazards regression model to conduct univariate and multivariate prognostic analyses, and a nomogram model was established to predict the survival of young advanced lung adenocarcinoma patients. The predictive performance of the nomogram was evaluated using ROC curves and calibration curves. X-Tile software was used for risk stratification of the prognosis of young advanced lung adenocarcinoma patients. Results From 2000 to 2020, the incidence rates of young lung adenocarcinoma in men and women in the US decreased from 2.1/100 000 and 2.2/100 000 to 1.1/100 000 and 1.5/100 000 respectively, with APCs of -2.16 and -1.39 (P<0.05). Compared to patients aged 40 to <50 years, patients under 40 were more likely to develop bone metastasis, liver metastasis, and lung metastasis, had a higher probability of receiving chemotherapy, tumors were more likely to occur in the lower or middle lobes of the lung, but had a lower probability of receiving radiotherapy, with statistically significant differences (P<0.05). Cox regression analysis showed that gender, age, race, N stage, M stage, subsite, liver metastasis, and bone metastasis were prognostic factors for young advanced lung adenocarcinoma patients (P<0.05); male patients had worse prognosis than female patients (HR=1.17, 95%CI 1.09-1.25); African American patients had worse prognosis than Caucasian patients (HR=1.12, 95%CI 1.02-1.23), other races had better prognosis than Caucasian patients (HR=0.83, 95%CI 0.77-0.97); patients aged 40 to <50 had worse prognosis than those under 40 (HR=1.34, 95%CI 1.21-1.48); patients with bone metastasis (HR=1.29, 95%CI 1.19-1.40) and liver metastasis (HR=1.40, 95%CI 1.28-1.54) had worse prognosis, with statistically significant differences (P<0.05). Based on the above prognostic factors, a nomogram model was established to predict 1-year, 3-year, and 5-year survival with areas under the curve (AUC) of 0.717, 0.692, and 0.699 respectively, and the calibration curve was close to the 45° diagonal. According to the risk scores, patients were divided into low-risk group [1017 cases (22.7%)], medium-risk group [2871 cases (63.9%)], and high-risk group [602 cases (13.4%)]. The difference is statistically significant comparing the survival rates among three groups (P<0.0001). Conclusion Gender, age, race, N stage, M stage, subsite, liver metastasis, and bone metastasis are prognostic factors for young advanced lung adenocarcinoma patients, and the nomogram model established based on these factors has high predictive performance.

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目的 基于美国SEER数据库相关数据，探究年轻肺腺癌晚期患者的发病情况、流行病学特征、治疗方式、预后评估和风险分层。方法 利用SEER*Stat软件收集2000-2020年美国<50岁人群的肺腺癌发病率，采用Joinpoint软件计算年度百分比变化(APCs)。回顾性收集SEER数据库中2010-2018年4490例<50岁的肺腺癌晚期患者临床数据进行分析。采用Kaplan-Meier法计算总生存期，log-rank检验估计生存率，采用Cox比例风险回归模型对研究队列进行单因素和多因素预后分析，并建立列线图模型预测年轻肺腺癌晚期患者的生存情况。采用ROC曲线及校准曲线评估列线图的预测效能。采用X-Tile软件对年轻肺腺癌晚期患者的预后进行风险分层。结果 2000-2020年，美国男、女年轻肺腺癌发病率由2.1/10万、2.2/10万分别下降到1.1/10万、1.5/10万，APCs分别为-2.16、-1.39(P<0.05)。与40~50岁肺腺癌晚期患者比较，<40岁患者易发生骨转移、肝转移和肺转移，接受化疗概率高，肿瘤易发生在肺下叶或中叶，但接受放疗的概率低，差异均有统计学意义(P<0.05)。Cox回归分析结果显示，性别、年龄、种族、N分期、M分期、亚部位、肝转移及骨转移是年轻肺腺癌晚期患者预后的影响因素(P<0.05)；男性较女性预后差(HR=1.17，95%CI 1.09~1.25)；黑人预后较白人差(HR=1.12，95%CI 1.02~1.23)，其他种族预后优于白人(HR=0.83，95%CI 0.77~0.97)；40~50岁患者预后较<40岁患者差(HR=1.34，95%CI 1.21~1.48)；发生骨转移(HR=1.29，95%CI 1.19~1.40)和肝转移(HR=1.40，95%CI 1.28~1.54)者预后差，差异均有统计学意义(P<0.05)。基于以上预后影响因素建立列线图模型，预测年轻肺腺癌晚期患者1、3、5年的生存曲线下面积(AUC)分别为0.717、0.692和0.699，校准曲线接近45°对角线。通过风险评分可将患者分为低风险组[1017例(22.7%)]、中风险组[2871例(63.9%)]和高风险组[602例(13.4%)]，3组生存概念比较，差异有统计学意义(P<0.0001)。结论 性别、年龄、种族、N分期、M分期、亚部位、肝转移和骨转移是年轻肺腺癌晚期患者的预后影响因素，据此建立的列线图模型预测效能较高。

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刘建，医学硕士，主管技师，主要从事公共卫生方面的研究

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刘建，医学硕士，主管技师，主要从事公共卫生方面的研究

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A. 列线图模型；B. 校准曲线；C. ROC曲线

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Basic data of young patients with advanced lung adenocarcinoma [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=

项目	<40岁 (n=728)	40~50岁 (n=3762)	合计 (n=4490)	χ2	P
性别				0.212	0.645
女	394(54.1)	2001(53.2)	2395(53.3)
男	334(45.9)	1761(46.8)	2095(46.7)
种族				22.694	<0.001
黑人	101(13.9)	588(15.6)	689(15.3)
白人	454(62.4)	2556(67.9)	3010(67.0)
其他	173(23.8)	618(16.4)	791(17.6)
T分期				15.248	0.002
T1	212 (29.1)	945 (25.1)	1157 (25.8)
T2	123(16.9)	803(21.3)	926(20.6)
T3	132(18.1)	804(21.4)	936(20.8)
T4	261(35.9)	1210(32.2)	1471(32.8)
N分期				8.253	0.041
N0	177(24.3)	939(25.0)	1116(24.9)
N1	61(8.4)	231(6.1)	292(6.5)
N2	275(37.8)	1568(41.7)	1843(41.0)
N3	215(29.5)	1024(27.2)	1239(27.6)
M分期				0.282	0.595
M1A	220(30.2)	1100(29.2)	1320(29.4)
M1B	508(69.8)	2662(70.8)	3170(70.6)
放疗				3.621	0.057
否	354(48.6)	1685(44.8)	2039(45.4)
是	374(51.4)	2077(55.2)	2451(54.6)
化疗				22.497	<0.001
否	134(18.4)	1007(26.8)	1141(25.4)
是	594(81.6)	2755(73.2)	3349(74.6)
骨转移				4.561	0.033
否	378(51.9)	2115(56.2)	2493(55.5)
是	350(48.1)	1647(43.8)	1997(44.5)
肺转移				8.836	0.003
否	467(64.1)	2623(69.7)	3090(68.8)
是	261(35.9)	1139(30.3)	1400(31.2)
脑转移				0.410	0.522
否	461(63.3)	2335(62.1)	2796(62.3)
是	267(36.7)	1427(37.9)	1694(37.7)
肝转移				4.254	0.039
否	580(79.7)	3117(82.9)	3697(82.3)
是	148(20.3)	645(17.1)	793(17.7)
分级				2.494	0.287
高分化	21(2.9)	74(2.0)	95(2.1)
中分化	77(10.6)	396(10.5)	473(10.5)
低分化	630(86.5)	3292(87.5)	3922(87.3)
患侧				1.483	0.476
双侧	61(8.4)	278(7.4)	339(7.6)
左侧	285(39.1)	1431(38.0)	1716(38.2)
右侧	382(52.5)	2053(54.6)	2435(54.2)
亚部位				36.090	<0.001
下叶	200(27.5)	839(22.3)	1039(23.1)
主支气管	26(3.6)	139(3.7)	165(3.7)
中叶	44(6.0)	164(4.4)	208(4.6)
交搭跨越	7(1.0)	48(1.3)	55(1.2)
未知	175(24.0)	714(19.0)	889(19.8)
上叶	276(37.9)	1858(49.4)	2134(47.5)

), ArticleFig(id=1198578979209839050, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558166339388087, language=CN, label=表1, caption=

年轻肺腺癌晚期患者的基线信息[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=

项目	<40岁 (n=728)	40~50岁 (n=3762)	合计 (n=4490)	χ2	P
性别				0.212	0.645
女	394(54.1)	2001(53.2)	2395(53.3)
男	334(45.9)	1761(46.8)	2095(46.7)
种族				22.694	<0.001
黑人	101(13.9)	588(15.6)	689(15.3)
白人	454(62.4)	2556(67.9)	3010(67.0)
其他	173(23.8)	618(16.4)	791(17.6)
T分期				15.248	0.002
T1	212 (29.1)	945 (25.1)	1157 (25.8)
T2	123(16.9)	803(21.3)	926(20.6)
T3	132(18.1)	804(21.4)	936(20.8)
T4	261(35.9)	1210(32.2)	1471(32.8)
N分期				8.253	0.041
N0	177(24.3)	939(25.0)	1116(24.9)
N1	61(8.4)	231(6.1)	292(6.5)
N2	275(37.8)	1568(41.7)	1843(41.0)
N3	215(29.5)	1024(27.2)	1239(27.6)
M分期				0.282	0.595
M1A	220(30.2)	1100(29.2)	1320(29.4)
M1B	508(69.8)	2662(70.8)	3170(70.6)
放疗				3.621	0.057
否	354(48.6)	1685(44.8)	2039(45.4)
是	374(51.4)	2077(55.2)	2451(54.6)
化疗				22.497	<0.001
否	134(18.4)	1007(26.8)	1141(25.4)
是	594(81.6)	2755(73.2)	3349(74.6)
骨转移				4.561	0.033
否	378(51.9)	2115(56.2)	2493(55.5)
是	350(48.1)	1647(43.8)	1997(44.5)
肺转移				8.836	0.003
否	467(64.1)	2623(69.7)	3090(68.8)
是	261(35.9)	1139(30.3)	1400(31.2)
脑转移				0.410	0.522
否	461(63.3)	2335(62.1)	2796(62.3)
是	267(36.7)	1427(37.9)	1694(37.7)
肝转移				4.254	0.039
否	580(79.7)	3117(82.9)	3697(82.3)
是	148(20.3)	645(17.1)	793(17.7)
分级				2.494	0.287
高分化	21(2.9)	74(2.0)	95(2.1)
中分化	77(10.6)	396(10.5)	473(10.5)
低分化	630(86.5)	3292(87.5)	3922(87.3)
患侧				1.483	0.476
双侧	61(8.4)	278(7.4)	339(7.6)
左侧	285(39.1)	1431(38.0)	1716(38.2)
右侧	382(52.5)	2053(54.6)	2435(54.2)
亚部位				36.090	<0.001
下叶	200(27.5)	839(22.3)	1039(23.1)
主支气管	26(3.6)	139(3.7)	165(3.7)
中叶	44(6.0)	164(4.4)	208(4.6)
交搭跨越	7(1.0)	48(1.3)	55(1.2)
未知	175(24.0)	714(19.0)	889(19.8)
上叶	276(37.9)	1858(49.4)	2134(47.5)

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