摘要
目的探讨基于美国国家癌症研究所监测、流行病学和最终结果(SEER)数据库直肠癌肝转移预后列线图预测模型的构建及其应用价值。方法采用回顾性队列研究方法。收集2010年1月至2016年12月SEER数据库(http://seer.cancer.gov/)6192例和海军军医大学第二附属医院收治的312例直肠癌肝转移患者的临床病理资料;6192例患者中,男3592例,女2600例;年龄<50岁1076例,50~69岁2862例,≥70岁2254例;312例患者中,男177例,女135例;年龄<50岁51例,50~59岁155例,≥70岁109例。SEER数据库患者为训练集,海军军医大学第二附属医院患者为验证集。采用单因素与多因素COX比例风险回归模型分析预后危险因素,构建直肠癌肝转移预后列线图预测模型并验证模型的准确性。训练集用于构建列线图预测模型,验证集用于验证列线图预测模型效能。观察指标:(1)直肠癌肝转移患者预后的影响因素分析。(2)直肠癌肝转移患者预后预测模型构建及评价。正态分布的计量资料以■±s表示,组间比较采用t检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验。等级资料比较采用秩和检验。采用COX回归模型进行单因素及多因素分析。采用Kaplan⁃Meier法计算生存率,采用Log⁃Rank检验进行生存分析。结果(1)直肠癌肝转移患者预后的影响因素分析。多因素分析结果显示:年龄>50岁、TNM分期为Ⅱ~Ⅳ期、T分期为3~4期、N分期为1~2期、清扫淋巴结总数目<12枚、肿瘤长径>5.1 cm、CEA阳性、发生周围神经侵犯、放疗、辅助化疗、肿瘤分化程度为低分化和未分化是患者预后的独立影响因素(P<0.05)。(2)直肠癌肝转移患者预后预测模型构建及评价。根据多因素分析结果,构建直肠癌肝转移患者预后列线图预测模型。该模型C⁃index为0.91,曲线下面积为0.726,判别能力较好。验证集校准曲线显示:列线图预测模型预测的直肠癌生存率与实际生存率相符。结论列线图预测模型能较准确预测结直肠癌肝转移患者的预后。
Objective To investigate the construction and application value of a nomogram predictive model for the prognosis of rectal cancer liver metastases based on Surveillance,Epidemiology,and End Results(SEER)database.Methods The retrospective cohort study was conducted.The clinicopathological data of 6192 patients with rectal cancer liver metastases in the SEER database(http://seer.cancer.gov/)and 312 patients who were admitted to The Second Affiliated Hospital of Naval Medical University January 2010 to December 2016 were collected.Of 6192 patients,there were 3592 males and 2600 cases.There were 1076 cases with age lower than 50 years,2862 cases with age as 50−69 years,2254 cases with age equal to or more than 70 years,respectively.Of 312 patients,there were 177 males and 135 cases.There were 51 cases with age lower than 50 years,155 cases with age as 50−69 years,109 cases with age equal to or more than 70 years,respectively.Patients of the SEER database were set as the training set,and patients in The Second Affiliated Hospital of Naval Medical University were set as the validation set.Univariate and multivariate COX proportional hazards regression models were used to analyze risk factors associated with prognosis,and construct and verify the accuracy of nomogram predictive model for the prognosis of rectal cancer liver metastasis.The training set were used to construct the nomogram prediction model,and the validation set were used to verify its performance.Observation indicators:(1)prognostic factors analysis in patients with rectal cancer liver metastases;(2)construction and verificative of the predictive model for the prognosis of rectal cancer liver metastasis.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test.Comparison of ordinal data was analyzed using the rank sum test.The COX regression model was used for univariate and multivariate analyses.Kaplan-Meier method was used to calculate survival rates,and Log-Rank test was used for survival analysis.Results(1)Prognostic factors analysis in patients with rectal cancer liver metastases.Results of multivariate analysis showed that age>50 years,TNM Ⅱ−Ⅳ stage,stage T3−T4,stage N1−N2,the number of lymph nodes dissected<12,tumor diameter>5.1 cm,positive carcinoembryonic antigen,peripheral nerve infiltration,radiotherapy and adjuvant chemotherapy,poorly differentiated or undifferented tumor were independent prognostic factors of patients(P<0.05).(2)Construction and verification of the predictive model for the prognosis of rectal cancer liver metastasis.A nomogram predictive model for the prognosis of rectal cancer liver metastasis was constructed based in the multivariate analysis.The C-index of the nomogram predictive model was 0.91,with area under the curve as 0.726,indicating a good discriminant ability.Results of the calibration curve in validation dataset showed that the colorectal cancer survival rate predicted by the nomogram predictive model was consistent with the actual survival rate.Conclusion The nomogram predictive model can accurately predict the survival probability of patients with rectal cancer liver metastases.
作者
应俊
孙亚煌
王安琪
卞策
陈国良
陶禹
陈俊楠
卢浩
游清
周海洋
王治国
阮灿平
张剑
Ying Jun;Sun Yahuang;Wang Anqi;Bian Ce;Chen Guoliang;Tao Yu;Chen Junnan;Lu Hao;You Qing;Zhou Haiyang;Wang Zhiguo;Ruan Canping;Zhang Jian(Department of Anorectal Surgery,The Second Affiliated Hospital of Naval Medical University(Shanghai Changzheng Hospital),Shanghai 200003,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第S01期51-57,共7页
Chinese Journal of Digestive Surgery
关键词
直肠肿瘤
肝转移
SEER数据库
预后
列线图预测模型
Rectal neoplasms
Liver metastasis
SEER database
Prognosis
Nomogram predictive model
