Background The purpose of this study is to predict overall survival (OS) and lung cancer-specific survival (LCSS) in patients with stage IIIA-N2 unresectable lung squamous cell cancer (LUSC), lung adenocarcinoma (LUAD), and large cell neuroendocrine cancer (LCNEC) by constructing nomograms and to compare risk and prognostic factors affecting survival outcomes in different histological subtypes. Methods We included 11,505 unresectable NSCLC patients at stage IIIA-N2 between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Moreover, competition models and nomograms were developed to predict prognostic factors for OS and LCSS. Results Analysis of the SEER database identified 11,505 NSCLC patients, of whom 5,559 (48.3%) have LUAD, 5,842 (50.8%) have LUSC, and 104 (0.9%) have LCNEC. Overall, both OS and LCSS were significantly better in stage IIIA-N2 unresectable LUAD than in LCNEC, while there was no statistically significant difference between LUSC and LCNEC. Age, gender, T stage, chemotherapy, and radiotherapy were significantly associated with OS rates in LUAD and LUSC. However, chemotherapy was the only independent factor for LCNEC (p < 0.01).From competitive risk models, we found that older age, larger tumors, non-chemotherapy and non-radiotherapy were associated with a increased risk of death from LUAD and LUSC. Unlike prognostic factors for OS, our study showed that both chemotherapy and radiotherapy were all LCNEC-specific survival factors for both LCSS and non-LCSS LCNEC. Conclusion Our study reports that unresectable patients with stage IIIA-N2 LCNEC and LUSC have worse LCSS than LUAD. The study's first prognostic nomogram constructed for patients with unresectable stage IIIA-N2 NSCLC can accurately predict the survival of different histological types, which may provide a practical tool to help clinicians assess prognosis and stratify these prognostic risks to determine which patients should be given an optimized individual treatment strategy based on histology.

中文翻译：

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基于风险分层列线图的开发和验证：与肺鳞状细胞癌和肺腺癌相比，预测 IIIA-N2 期不可切除的大细胞肺神经内分泌癌中肺癌特异性死亡率的风险。

背景 本研究的目的是预测 IIIA-N2 期不可切除的肺鳞状细胞癌 (LUSC)、肺腺癌 (LUAD) 和大细胞神经内分泌癌患者的总生存期 (OS) 和肺癌特异性生存期 (LCSS) (LCNEC) 通过构建列线图并比较影响不同组织学亚型生存结果的风险和预后因素。方法 我们从监测、流行病学和最终结果 (SEER) 数据库中纳入了 2010 年至 2015 年间 11,505 名 IIIA-N2 期不可切除的 NSCLC 患者。此外，还开发了竞争模型和列线图来预测 OS 和 LCSS 的预后因素。结果 SEER 数据库分析确定了 11,505 名 NSCLC 患者，其中 5,559 名（48.3%）患有 LUAD，5,842 名（50.8%）患有 LUSC，104 名（0.9%）患有 LCNEC。全面的，IIIA-N2 期不可切除 LUAD 的 OS 和 LCSS 均显着优于 LCNEC，而 LUSC 和 LCNEC 之间无统计学差异。年龄、性别、T 分期、化疗和放疗与 LUAD 和 LUSC 的 OS 率显着相关。然而，化疗是 LCNEC 的唯一独立因素 (p < 0.01)。从竞争风险模型中，我们发现年龄较大、肿瘤较大、非化疗和非放疗与 LUAD 和 LUSC 死亡风险增加相关。与 OS 的预后因素不同，我们的研究表明化疗和放疗都是 LCSS 和非 LCSS LCNEC 的 LCNEC 特异性生存因素。结论 我们的研究表明，不可切除的 IIIA-N2 期 LCNEC 和 LUSC 患者的 LCSS 比 LUAD 差。研究'