Rachel score: a nomogram model for predicting the prognosis of lung neuroendocrine tumors.
Lung NET
Neuroendocrine tumors
Nomogram
Primary tumor location
Prognostic score
Journal
Journal of endocrinological investigation
ISSN: 1720-8386
Titre abrégé: J Endocrinol Invest
Pays: Italy
ID NLM: 7806594
Informations de publication
Date de publication:
23 Mar 2024
23 Mar 2024
Historique:
received:
01
08
2023
accepted:
19
02
2024
medline:
23
3
2024
pubmed:
23
3
2024
entrez:
23
3
2024
Statut:
aheadofprint
Résumé
Lung NET, classified in typical carcinoids (TC) and atypical carcinoids (AC), are highly heterogeneous in their biology and prognosis. The histological subtype and TNM stage are well-established prognostic factors for lung NET. In a previous work by our group, we demonstrated a significant impact of laterality on lung NET survival outcomes. We developed a nomogram that integrates relevant prognostic factors to predict lung NET outcomes. By adding the scores for each of the variables included in the model, it was possible to obtain a prognostic score (Rachel score). Wilcoxon non-parametric statistical test was applied among parameters and Harrell's concordance index was used to measure the models' predictive power. To test the discriminatory power and the predictive accuracy of the model, we calculated Gonen and Heller concordance index. Time-dependent ROC curves and their area under the curve (AUC) were used to evaluate the models' predictive performance. By applying Rachel score, we were able to identify three prognostic groups (specifically, high, medium and low risk). These three groups were associate to well-defined ranges of points according to the obtained nomogram (I: 0-90, II: 91-130; III: > 130 points), providing a useful tool for prognostic stratification. The overall survival (OS) and progression free survival (PFS) Kaplan-Meier curves confirmed significant differences (p < 0.0001) among the three groups identified by Rachel score. A prognostic nomogram was developed, incorporating variables with significant impact on lung NET survival. The nomogram showed a satisfactory and stable ability to predict OS and PFS in this population, confirming the heterogeneity beyond the histopathological diagnosis of TC vs AC.
Sections du résumé
BACKGROUND
BACKGROUND
Lung NET, classified in typical carcinoids (TC) and atypical carcinoids (AC), are highly heterogeneous in their biology and prognosis. The histological subtype and TNM stage are well-established prognostic factors for lung NET. In a previous work by our group, we demonstrated a significant impact of laterality on lung NET survival outcomes.
MATERIALS AND METHODS
METHODS
We developed a nomogram that integrates relevant prognostic factors to predict lung NET outcomes. By adding the scores for each of the variables included in the model, it was possible to obtain a prognostic score (Rachel score). Wilcoxon non-parametric statistical test was applied among parameters and Harrell's concordance index was used to measure the models' predictive power. To test the discriminatory power and the predictive accuracy of the model, we calculated Gonen and Heller concordance index. Time-dependent ROC curves and their area under the curve (AUC) were used to evaluate the models' predictive performance.
RESULTS
RESULTS
By applying Rachel score, we were able to identify three prognostic groups (specifically, high, medium and low risk). These three groups were associate to well-defined ranges of points according to the obtained nomogram (I: 0-90, II: 91-130; III: > 130 points), providing a useful tool for prognostic stratification. The overall survival (OS) and progression free survival (PFS) Kaplan-Meier curves confirmed significant differences (p < 0.0001) among the three groups identified by Rachel score.
CONCLUSIONS
CONCLUSIONS
A prognostic nomogram was developed, incorporating variables with significant impact on lung NET survival. The nomogram showed a satisfactory and stable ability to predict OS and PFS in this population, confirming the heterogeneity beyond the histopathological diagnosis of TC vs AC.
Identifiants
pubmed: 38520655
doi: 10.1007/s40618-024-02346-x
pii: 10.1007/s40618-024-02346-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Italian Society of Endocrinology (SIE).
Références
Nicholson AG, Tsao MS, Beasley MB, Borczuk AC, Brambilla E, Cooper WA, Dacic S, Jain D, Kerr KM, Lantuejoul S, Noguchi M, Papotti M, Rekhtman N, Scagliotti G, van Schil P, Sholl L, Yatabe Y, Yoshida A, Travis WD (2022) The 2021 WHO classification of lung tumors: impact of advances Since 2015. J Thorac Oncol 17(3):362–387. https://doi.org/10.1016/j.jtho.2021.11.003
doi: 10.1016/j.jtho.2021.11.003
pubmed: 34808341
Rindi G, Moch H, McCluggage WG, et al (2022) Neuroendocrine neoplasms, non-endocrine organs. In: WHO Classification of Tumours Editorial Board, editor. WHO classification of tumours endocrine and neuroendocrine tumours. 5th ed. Lyon, France: International Agency for Research on Cancer (IARC)
Filosso PL, Rena O, Donati G, Casadio C, Ruffini E, Papalia E et al (2002) Bronchial carcinoid tumors: surgical management and long-term outcome. J Thorac Cardiovasc Surg 123(2):303–309
doi: 10.1067/mtc.2002.119886
pubmed: 11828290
Alcala N, Leblay N, Gabriel AAG, Mangiante L, Hervas D, Giffon T et al (2019) Integrative and comparative genomic analyses identify clinically relevant pulmonary carcinoid groups and unveil the supra-carcinoids. Nat Commun 10(1):3407
doi: 10.1038/s41467-019-11276-9
pubmed: 31431620
pmcid: 6702229
Abdel-Rahman O (2018) Modified staging system for pulmonary carcinoids on the basis of lung cancer TNM system. Clin Transl Oncol 20(5):670–677
doi: 10.1007/s12094-017-1759-2
pubmed: 29022170
Kneuertz PJ, Kamel MK, Stiles BM, Lee BE, Rahouma M, Harrison SW et al (2018) Incidence and prognostic significance of carcinoid lymph node metastases. Ann Thorac Surg 106(4):981–988
doi: 10.1016/j.athoracsur.2018.05.044
pubmed: 29908980
Dermawan JK, Farver CF (2019) The prognostic significance of the 8th Edition TNM staging of pulmonary carcinoid tumors: a single Institution Study with long-term follow-up. Am J Surg Pathol 43(9):1291–1296
Cattoni M, Vallières E, Brown LM, Sarkeshik AA, Margaritora S, Siciliani A et al (2018) Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size. J Thorac Cardiovasc Surg 155(1):405–413
doi: 10.1016/j.jtcvs.2017.08.102
pubmed: 28986041
Jackson AS, Rosenthal A, Cattoni M, Bograd AJ, Farivar AS, Aye RW et al (2020) Staging system for neuroendocrine tumors of the lung needs to incorporate histologic grade. Ann Thorac Surg 109(4):1009–1018
doi: 10.1016/j.athoracsur.2019.09.053
pubmed: 31706866
La Salvia A, Persano I, Siciliani A, Verrico M, Bassi M, Modica R et al (2022) Prognostic significance of laterality in lung neuroendocrine tumors. Endocrine 76(3):733–746
doi: 10.1007/s12020-022-03015-w
pubmed: 35301675
pmcid: 9156515
La Salvia A, Carletti R, Verrico M, Feola T, Puliani G, Bassi M et al (2022) Angioside: the role of angiogenesis and hypoxia in lung neuroendocrine tumours according to primary tumour location in left or right parenchyma. J Clin Med 11(19):5958
doi: 10.3390/jcm11195958
pubmed: 36233825
pmcid: 9570740
Newson RB (2010) Comparing the predictive powers of survival models using Harrell’s C or Somers’ D. Stand Genomic Sci 10(3):339–358. https://doi.org/10.1177/1536867X1001000303
doi: 10.1177/1536867X1001000303
Gönen M, Heller G (2005) Concordance probability and discriminatory power in proportional hazards regression. Biometrika 92(4):965–970. https://doi.org/10.1093/biomet/92.4.965
doi: 10.1093/biomet/92.4.965
Kneuertz PJ, Kamel MK, Stiles BM, Lee BE, Rahouma M, Harrison SW, Altorki NK, Port JL (2018) Incidence and prognostic significance of carcinoid lymph node metastases. Ann Thorac Surg 106(4):981–988. https://doi.org/10.1016/j.athoracsur.2018.05.044
doi: 10.1016/j.athoracsur.2018.05.044
pubmed: 29908980
Righi L, Volante M, Rapa I, Vatrano S, Pelosi G, Papotti M (2014) Therapeutic biomarkers in lung neuroendocrine neoplasia. Endocr Pathol 25(4):371–377. https://doi.org/10.1007/s12022-014-9335-6
doi: 10.1007/s12022-014-9335-6
pubmed: 25252622
Iasonos A, Schrag D, Raj GV, Panageas KS (2008) How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 26(8):1364–1370. https://doi.org/10.1200/JCO.2007.12.9791
doi: 10.1200/JCO.2007.12.9791
pubmed: 18323559
Balachandran VP, Gonen M, Smith JJ, DeMatteo RP (2015) Nomograms in oncology: more than meets the eye. Lancet Oncol 16(4):e173–e180. https://doi.org/10.1016/S1470-2045(14)71116-7
doi: 10.1016/S1470-2045(14)71116-7
pubmed: 25846097
pmcid: 4465353
Liao T, Su T, Huang L, Li B, Feng LH (2022) Development and validation of a novel nomogram for predicting survival rate in pancreatic neuroendocrine neoplasms. Scand J Gastroenterol 57(1):85–90. https://doi.org/10.1080/00365521.2021.1984571
doi: 10.1080/00365521.2021.1984571
pubmed: 34592854
Zhou S, Jiang S, Chen W, Yin H, Dong L, Zhao H, Han S, He X (2021) Biliary neuroendocrine neoplasms: analysis of prognostic factors and development and validation of a nomogram. Front Oncol 19(11):654439. https://doi.org/10.3389/fonc.2021.654439
doi: 10.3389/fonc.2021.654439
Xie S, Li L, Wang X, Li L (2021) Development and validation of a nomogram for predicting the overall survival of patients with gastroenteropancreatic neuroendocrine neoplasms. Medicine (Baltimore) 100(2):e24223. https://doi.org/10.1097/MD.0000000000024223
doi: 10.1097/MD.0000000000024223
pubmed: 33466202
Zhang X, Lu L, Liu J, Liu W, Li L, Wei Y, Fan J, Ma L, Gong P (2022) A nomogram to accurately identify pancreatic neuroendocrine tumors metastasizing to distant organs: a study based on two national population-based Cohorts from the United States and China. Clin Med Insights Oncol 19(16):11795549221099852. https://doi.org/10.1177/11795549221099853
doi: 10.1177/11795549221099853
Chen Q, Chen J, Deng Y, Zhang Y, Huang Z, Zhao H, Cai J (2022) Nomogram for the prediction of lymph node metastasis and survival outcomes in rectal neuroendocrine tumour patients undergoing resection. J Gastrointest Oncol 13(1):171–184. https://doi.org/10.21037/jgo-21-573
doi: 10.21037/jgo-21-573
pubmed: 35284104
pmcid: 8899747
Zhang S, Tong YX, Zhang XH, Zhang YJ, Xu XS, Xiao AT, Chao TF, Gong JP (2019) A novel and validated nomogram to predict overall survival for gastric neuroendocrine neoplasms. J Cancer 10(24):5944–5954. https://doi.org/10.7150/jca.35785
doi: 10.7150/jca.35785
pubmed: 31762804
pmcid: 6856574
Levy S, van Veenendaal LM, Korse CM, Breekveldt ECH, Verbeek WHM, Vriens MR, Kuhlmann KFD, van den Berg JG, Valk GD, Tesselaar MET (2020) Survival in patients with neuroendocrine tumours of the small intestine: nomogram validation and predictors of survival. J Clin Med 9(8):2502. https://doi.org/10.3390/jcm9082502
doi: 10.3390/jcm9082502
pubmed: 32756529
pmcid: 7464451
Huang XT, Xie JZ, Huang CS, Li JH, Chen W, Liang LJ, Yin XY (2022) Development and validation of nomogram to predict lymph node metastasis preoperatively in patients with pancreatic neuroendocrine tumor. HPB (Oxford) 24(12):2112–2118. https://doi.org/10.1016/j.hpb.2022.08.015
doi: 10.1016/j.hpb.2022.08.015
pubmed: 36127226
Lin Z, Wang H, Zhang Y, Li G, Pi G, Yu X, Chen Y, Jin K, Chen L, Yang S, Zhu Y, Wu G, Chen J, Zhang T (2020) Development and validation of a prognostic nomogram to guide decision-making for high-grade digestive neuroendocrine neoplasms. Oncologist 25(4):e659–e667. https://doi.org/10.1634/theoncologist.2019-0566
doi: 10.1634/theoncologist.2019-0566
pubmed: 32297441
Yang Y, Shen C, Shao J, Wang Y, Wang G, Shen A (2022) Based on the development and verification of a risk stratification nomogram: predicting the risk of lung cancer-specific mortality in stage IIIA-N2 unresectable large cell lung neuroendocrine cancer compared with lung squamous cell cancer and lung adenocarcinoma. Front Oncol 30(12):825598. https://doi.org/10.3389/fonc.2022.825598
doi: 10.3389/fonc.2022.825598
Xi J, Zhao M, Zheng Y, Liang J, Hu Z, Huang Y, Yang Y, Zhan C, Jiang W, Lu T, Guo W, Wang Q (2020) Development and validation of a nomogram for predicting the overall survival of patients with lung large cell neuroendocrine carcinoma. Transl Cancer Res 9(8):4943–4957. https://doi.org/10.21037/tcr-20-780
doi: 10.21037/tcr-20-780
pubmed: 35117856
pmcid: 8799202
Xiong L, Jiang Y, Hu T (2022) Prognostic nomograms for lung neuroendocrine carcinomas based on lymph node ratio: a SEER database analysis. J Int Med Res 50(9):3000605221115160. https://doi.org/10.1177/03000605221115160
doi: 10.1177/03000605221115160
pubmed: 36076355
He Y, Liu H, Wang S, Chen Y (2019) Prognostic nomogram predicts overall survival in pulmonary large cell neuroendocrine carcinoma. PLoS ONE 14(9):e0223275. https://doi.org/10.1371/journal.pone.0223275
doi: 10.1371/journal.pone.0223275
pubmed: 31560723
pmcid: 6764685
Song Z, Zou L (2022) Risk factors, survival analysis, and nomograms for distant metastasis in patients with primary pulmonary large cell neuroendocrine carcinoma: a population-based study. Front Endocrinol (Lausanne) 17(13):973091. https://doi.org/10.3389/fendo.2022.973091
doi: 10.3389/fendo.2022.973091
Wang S, Wei J, Guo Y, Xu Q, Lv X, Yu Y, Liu M (2022) Construction and validation of nomograms based on the log odds of positive lymph nodes to predict the prognosis of lung neuroendocrine tumors. Front Immunol 23(13):987881. https://doi.org/10.3389/fimmu.2022.987881
doi: 10.3389/fimmu.2022.987881
Gagliardi I, Tarquini M, Ambrosio MR, Giannetta E, Borges de Souza P, Gafà R, Carnevale A, Franceschetti P, Zatelli MC (2021) NEP-score thresholds predict survival of patients with bronchial carcinoids. Front Endocrinol (Lausanne). 11:621557. https://doi.org/10.3389/fendo.2020.621557
doi: 10.3389/fendo.2020.621557
pubmed: 33628200
pmcid: 7897663
Ferolla P, Daddi N, Urbani M, Semeraro A, Ribacchi R, Giovenali P, Ascani S, De Angelis V, Crinò L, Puma F, Daddi G; Regional multidisciplinary Group for the diagnosis and treatment of neuroendocrine tumors, CRO, Umbria Region Cancer Network, Italy (2009) Tumorlets, multicentric carcinoids, lymph-nodal metastases, and long-term behavior in bronchial carcinoids. J Thorac Oncol 4(3):383–387. https://doi.org/10.1097/JTO.0b013e318197f2e7
Daddi N, Ferolla P, Urbani M, Semeraro A, Avenia N, Ribacchi R, Puma F, Daddi G (2004) Surgical treatment of neuroendocrine tumors of the lung. Eur J Cardiothorac Surg 26(4):813–817. https://doi.org/10.1016/j.ejcts.2004.05.052
doi: 10.1016/j.ejcts.2004.05.052
pubmed: 15450578
Caplin ME, Baudin E, Ferolla P, Filosso P, Garcia-Yuste M, Lim E, Oberg K, Pelosi G, Perren A, Rossi RE, Travis WD; ENETS consensus conference participants (2015) Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. Ann Oncol 26(8):1604–1620. https://doi.org/10.1093/annonc/mdv041
Baudin E, Caplin M, Garcia-Carbonero R, Fazio N, Ferolla P, Filosso PL, Frilling A, de Herder WW, Hörsch D, Knigge U, Korse CM, Lim E, Lombard-Bohas C, Pavel M, Scoazec JY, Sundin A, Berruti A; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org (2021) Lung and thymic carcinoids: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up