摘要
目的为了预测肿瘤特异性生存期(CSS),我们开发了一种新的列线图模型和风险分级系统来对转移性结直肠癌(mCRC)患者的风险水平进行分类。方法数据提取自2010年~2015年的美国Surveillance,Epidemiology,and End Results(SEER)数据库。所有符合条件的病例被随机分为训练队列和验证队列。采用Cox比例风险模型探讨CSS的独立危险因素。开发了一种新的列线图模型来预测CSS,并通过内部验证和外部验证进行评估。结果利用多变量Cox比例风险模型,确定CSS的独立危险因素。然后根据这些因素开发新的CSS列线图。该列线图的一致性指数(C-index)为0.718(95%CI:0.712~0.725),验证队列的一致性指数为0.722(95%CI:0.711~0.732),表明良好的鉴别能力,且优于TNM分期(C-index:训练集,0.533,95%CI,0.525~0.540;验证集,0.524,95%CI,0.513~0.535)。校正图和临床决策曲线(DCA)具有良好的一致性和良好的潜在临床效度。风险分级系统将所有患者分为三组,Kaplan-Meier曲线显示不同组间CSS具有良好的分层和区分能力。在总队列中,低危组、中危组和高危组患者的中位CSS分别为36个月(95%CI:34.987~37.013)、18个月(95%CI:17.273~18.727)和5个月(95%CI:4.503~5.497)。结论我们开发了一种新的列线图模型来预测同时性mCRC患者的CSS。此外,风险分级系统有助于准确评估预后和指导治疗。
Objective To predict cancer-specific survival(CSS),we developed a novel nomogram model and a risk classification system for classifying risk levels of metastatic colorectal cancer(mCRC)patients.Methods The data was extracted from the National Cancer Institute's Surveillance,Epidemiology,and End Results(SEER)database between 2010 to 2015.All eligible cases were randomly divided into training and validating cohorts.Cox proportional hazards model was used to explore the independent risk factors for CSS.A novel nomogram model was developed to predict the CSS and evaluated via internal and external validations.Results Using the multivariate Cox proportional hazards model,the independent risk factors were identified for CSS.Then a novel nomogram was developed for CSS based on such factors.The concordance indexes(C-index)were 0.718(95%CI:0.712~0.725)for this nomogram and 0.722(95%CI:0.711~0.732)for the validating cohort,indicating a good discrimination.The calibration plots and decision curve analysis(DCA)showed good consistency and nice potential clinical validity.A risk classification system divided all patients into three groups and Kaplan-Meier curves indicated good stratification and discrimination for CSS among different groups.In the total cohorts,the median CSS of patients in the lowrisk,intermediate-risk,and high-risk groups was 36 months(95%CI:34.987~37.013),18 months(95%CI:17.273~18.727),and 5 months(95%CI:4.503~5.497),respectively.Conclusions We developed a novel nomogram model to predict the CSS for synchronous mCRC patients.Furthermore,a risk classification system could contribute to accurately assessing the prognosis and guiding treatment.
作者
刘恩瑞
关旭
郭雅琪
魏然
马晓龙
姜争
刘正
陈瑛罡
王锡山
Liu Enrui;Guan Xu;Guo Yaqi;Wei Ran;Ma Xiaolong;Jiang Zheng;Liu Zheng;Chen Yinggang;Wang Xishan(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Bejing 100021,China;Department of Anesthesiology,Affiliated Hospital of Qingdao University,Qingdao 266003,China;Department of General Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University,Nanjing 21008,China;Department of Gastrointestinal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,China)
出处
《中华结直肠疾病电子杂志》
2021年第6期576-584,共9页
Chinese Journal of Colorectal Diseases(Electronic Edition)
基金
中国医学科学院创新基金(CIFMS)(No.2016-I2M-1-001)
深圳市‘医疗卫生三名工程’(No.SZSM201911012)。
