The standard treatment of stage III N2 small cell lung cancer (SCLC) is concurrent chemoradiation, and surgery is not recommended. This study was aimed to evaluate whether surgery has survival benefits in patients with stage III N2 SCLC and investigate the factors influencing survival of surgery. Patients diagnosed with stage T1-4N2M0 SCLC from 2004 to 2015 were selected from the Surveillance Epidemiology End Results database. Propensity score matching (PSM) was used to balance confounders between patients who underwent surgery and those treated with radiation and/or chemotherapy. We compared overall survival (OS) of the two groups using Kaplan-Meier curves and a Cox proportional hazard model. We also identified prognostic factors in patients with surgical resection, and a nomogram was developed and validated for predicting postoperative OS. −A total of 5576 patients were included in the analysis; of these, 211 patients underwent surgery. PSM balanced the differences between the two groups. The median OS was longer in the surgery group than in the non-surgery group (20 vs. 15 months; p = 0.0024). Surgery was an independent prognostic factor for longer OS in the multivariate Cox regression analysis, and subgroup analysis revealed a higher survival rate in T1 stage patients treated with surgery (hazard ratio = 0.565, 95% confidence interval: 0.401–0.798; p = 0.001). In patients who underwent surgery, four prognostic factors, including age, T stage, number of positive lymph nodes, and radiation, were selected into nomogram development for predicting postoperative OS. C-index, decision curve analyses, integrated discrimination improvement, and time-dependent receiver operating characteristics showed better performance in nomogram than in the tumor-node-metastasis staging system. Calibration plots demonstrated good consistency between nomogram predicted survival and actual observed survival. The patients were stratified into three different risk groups by prognostic scores and Kaplan-Meier curves showed significant difference between these groups. These results indicate that surgery can prolong survival in patients with operable stage III N2 SCLC, particularly those with T1 disease. A nomogram that includes age, T stage, number of positive lymph nodes, and radiation can be used to predict their long-term postoperative survival.

中文翻译：

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手术对 III 期 N2 小细胞肺癌患者生存率的影响：倾向评分匹配分析和列线图开发和验证

III 期 N2 小细胞肺癌 (SCLC) 的标准治疗是同步放化疗，不推荐手术。本研究旨在评估手术是否对 III 期 N2 SCLC 患者的生存有益，并探讨影响手术生存的因素。从监测流行病学最终结果数据库中选择了 2004 年至 2015 年诊断为 T1-4N2M0 期 SCLC 的患者。倾向评分匹配 (PSM) 用于平衡接受手术的患者与接受放疗和/或化疗的患者之间的混杂因素。我们使用 Kaplan-Meier 曲线和 Cox 比例风险模型比较了两组的总生存期 (OS)。我们还确定了手术切除患者的预后因素，并开发并验证了列线图以预测术后 OS。− 共有 5576 名患者被纳入分析；其中，211 名患者接受了手术。PSM 平衡了两组之间的差异。手术组的中位 OS 比非手术组长（20 个月 vs. 15 个月；p = 0.0024）。在多变量 Cox 回归分析中，手术是延长 OS 的独立预后因素，亚组分析显示接受手术治疗的 T1 期患者的生存率更高（风险比 = 0.565，95% 置信区间：0.401–0.798；p = 0.001） . 在接受手术的患者中，四个预后因素，包括年龄、T 分期、阳性淋巴结数量和辐射，被选入列线图开发以预测术后 OS。C-index、决策曲线分析、综合鉴别改进、和时间相关的接收器操作特性在列线图中显示出比在肿瘤-淋巴结-转移分期系统中更好的性能。校准图表明列线图预测的存活率和实际观察到的存活率之间具有良好的一致性。根据预后评分将患者分为三个不同的风险组，Kaplan-Meier 曲线显示这些组之间存在显着差异。这些结果表明，手术可以延长可手术的 III 期 N2 SCLC 患者的生存期，尤其是那些 T1 期患者。包括年龄、T 分期、阳性淋巴结数量和辐射的列线图可用于预测其长期术后存活率。校准图表明列线图预测的存活率和实际观察到的存活率之间具有良好的一致性。根据预后评分将患者分为三个不同的风险组，Kaplan-Meier 曲线显示这些组之间存在显着差异。这些结果表明，手术可以延长可手术的 III 期 N2 SCLC 患者的生存期，尤其是那些 T1 期患者。包括年龄、T 分期、阳性淋巴结数量和辐射的列线图可用于预测其长期术后存活率。校准图表明列线图预测的存活率和实际观察到的存活率之间具有良好的一致性。根据预后评分将患者分为三个不同的风险组，Kaplan-Meier 曲线显示这些组之间存在显着差异。这些结果表明，手术可以延长可手术的 III 期 N2 SCLC 患者的生存期，尤其是那些 T1 期患者。包括年龄、T 分期、阳性淋巴结数量和辐射的列线图可用于预测其长期术后存活率。这些结果表明，手术可以延长可手术的 III 期 N2 SCLC 患者的生存期，尤其是那些 T1 期患者。包括年龄、T 分期、阳性淋巴结数量和辐射的列线图可用于预测其长期术后存活率。这些结果表明，手术可以延长可手术的 III 期 N2 SCLC 患者的生存期，尤其是那些 T1 期患者。包括年龄、T 分期、阳性淋巴结数量和辐射的列线图可用于预测其长期术后存活率。