Prognostic nomogram and epidemiological analysis for lung atypical carcinoid: A SEER database and external validation study

Abstract

Abstract Purpose We aimed to investigate the annual percentage change (APC) in the proportion of AC in lung carcinoids to determine the epidemiology of AC and to develop a comprehensive nomogram that could reliably evaluate the prognosis of patients with AC. Methods The demographic and treatment information of AC patients were extracted retrospectively from the Surveillance, Epidemiology, and End Results database (SEER) and a separate medical centre in China. A joinpoint regression model was applied to determine the proportional trend of the AC. Univariate and least absolute shrinkage and selection operator (LASSO)-based Cox regression models were used to identify independent factors, and a nomogram and web-based predictor were developed to evaluate prognosis individually. The receiver operating characteristic curve, the area under the ROC, calibration plots, and decision curve analysis were performed to assess the model. Results Most patients with AC were women (60.5%); the mean age of AC patients was 63.4 years, with a lower tumour site (42.7%), T1 (51.5%), N1 (64.4%), and M0 (87.1%). The proportion of patients with AC and pulmonary carcinoids increased annually from 6.3% in 2004 to 10.5% in 2010 and 16.1% in 2019. Age at diagnosis, primary tumour site, surgery, and tumour-node-metastasis (TNM) stage were independent risk factors in patients with AC. The nomogram predicted 1, 3, and 5 years of AC with excellent accuracy and discrimination. Conclusion The proportion of patients with AC and pulmonary carcinoids increased annually. The nomogram and web-based predictors were more accurate and discriminative than the TNM stage.