摘要
目的探讨儿童以及成人髓母细胞瘤(MB)的临床特征、总体生存率(OS)和预后因素并构建相应的临床预后预测模型。方法下载SEER数据库中MB患者的临床资料并根据年龄分为儿童(<18岁)及成人(≥18岁)患者。采用Kaplan-Meier函数分别绘制儿童和成人患者各临床因素的生存曲线,采用Log-rank法比较二者差异;采用单因素、多因素Cox回归分析评估各临床因素对患者预后的影响,并将预后相关的临床因素(P<0.05)分别纳入儿童或成人患者列线图的构建,用Bootstrap自抽样法进行内部验证;用一次性指数(C-index)和校准曲线评估列线图的准确性。结果儿童与成人MB均好发于男性,肿瘤多位于小脑,以经典型(CL)最为常见。儿童患者的3、5和10年的OS分别为79.1%、74.2%和67.7%,成人患者的3、5和10年OS分别为84.0%、77.0%和68.6%,二者比较差异无统计学意义(P>0.05)。0~3岁儿童患者3、5和10年OS分别为68.5%、65.5%和61.5%,>3岁的儿童患者3、5和10年OS分别为82.9%、77.4%和69.9%,二者OS比较差异有统计学意义(P<0.05)。年龄、组织学类型、手术方式、放疗史及化疗史是儿童患者的独立预后因素,放疗史为成人患者的独立预后因素。构建的列线图能够较好地预测儿童及成人患者的预后情况,C-index分别为0.67及0.61,模型的校准曲线表明列线图预测生存率与实际生存率有较高的拟合度。结论儿童与成人MB在性别、肿瘤好发部位以及组织学常见类型等临床特征上相似。儿童及成人MB患者OS相近,不同年龄段的儿童患者OS存在明显的差异。构建的列线图能够较好地预测儿童以及成人MB患者的OS。
Objective To explore the clinical characteristics,overall survival rate and prognostic factors of medulloblastoma in children and adults,and construct corresponding clinical prognosis prediction models according to different populations.Methods By downloading the clinical data of medulloblastoma from SEER database and divided into children group(<18 years old)and adult group(≥18 years old)according to age.First,the survival curves of the children group and the adult group were drawn using the Kaplan-Meier function,and the Log-rank method was used to compare the differences between the two groups.Secondly,the KM function was used to draw the survival curves of each clinical factor and children and adult patients.Then,univariate and multivariate COX regression analysis was used to evaluate the relationship between each clinical factor and patient prognosis,and the corresponding hazard ratio with 95%confidence interval predicted the influence of each clinical factor on prognosis.Finally,these prognostic factors were included in the construction of nomograms for children and adults,and the Bootstrap self-sampling method was used for internal validation,and assessed the accuracy of nomograms by concordance index(C-index)and calibration curve.Results Both pediatric and adult medulloblastomas are more common in males,and the tumors are mostly located in the cerebellum.Classical medulloblastoma is the most common.The 3-,5-,and 10-year overall survival rates for children were 79.1%,74.2%,and 67.7%,and the 3-,5-,and 10-year overall survival rates for adults were 84.0%,77.0%,and 68.6%.There was no statistical difference between the two groups(P>0.05).However,the 3-,5-,and 10-year overall survival rates for 0-3 years old children were 68.5%、65.5%and 61.5%,which was significantly different(P<0.05)from>3 years old children whose 3-,5-,and 10-year survival rartes were 82.9%、77.4%and 69.9%.The results of COX regression analysis showed that age,histological type,surgical method,radiotherapy and chemotherapy were independent prognostic factors in children,and only radiotherapy was an independent prognostic factor in adults.The constructed nomogram can better predict the prognosis of children and adults.The C-index is 0.67 and 0.61 respectively.The constructed nomogram can better predict the prognosis of children and adults,with C-index of 0.67 and 0.61,respectively.The calibration curve of the model shows that the survival rate predicted by the nomogram is close to the actual survival rate.Conclusion Children and adult medulloblastoma are similar in clinical features including gender,tumor location,and common histological types.The overall survival rates of children and adults with medulloblastoma are similar,and there are significant differences in overall survival between children with different age groups.The constructed nomogram can better predict the overall survival rate of children and adults with medulloblastoma.
作者
刘裕
魏锋
肖爵贤
桂诗凯
程天祥
程祖珏
LIU Yu;WEI Feng;XIAO Jue-xian;GUI Shi-kai;CHENG Tian-xiang;CHENG Zu-jue(Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Neurosurgery,Hospital of Traditional Chinese Medicine of Zhongshan,Zhongshan 528401,China;Department of Neurosurgery,Yushan Huang Jia Si Hospital,Yushan 334700,China)
出处
《南昌大学学报（医学版）》
2022年第6期49-57,共9页
Journal of Nanchang University：Medical Sciences
基金
江西省教育厅科学技术研究项目(GJJ200133)
江西省卫健委科技项目(202130349)。
