预测淋巴结阳性阴茎癌手术后无病生存率列线图的建立

Construction of a nomogram to predict disease free survival in node-positive penile cancer treated with surgery

目的建立预测淋巴结阳性阴茎癌患者手术后无病生存率的列线图。方法回顾性分析32例淋巴结阳性阴茎鳞状细胞癌患者的临床病理资料。患者均接受了阴茎肿瘤切除和区域淋巴结清扫术。N1期10例，N2期13例，N3期9例。术前鳞状细胞癌抗原（SCCAg）水平0—19．8μg／L，中位值为0．9μg／L。随访3—31个月，中位时间16．5个月。患者出现疾病复发13例。预后指标包括分期、分级和术前SCCAg水平。采用Cox回归模型建立列线图。结果血清SCCAg水平的风险比值为2．76（95％CI：1．40～5．44，P=0．0034），而N分期的风险比值为28．51（95％C1：2．55～319．11，P=0．0066）。列线图一致系数为0．862，经过自助法校正后为0．855；校正曲线显示模型的符合度良好。N分期和术前SCCAg水平是预测淋巴结阳性阴茎癌患者手术后无病生存率的独立预后因素。结论基于分期和术前SCCAg水平，构建预测淋巴结阳性阴茎癌手术后无病生存率的列线图，有助于个体化判断肿瘤复发的风险及与患者交流和综合治疗选择。

Objective To construct a nomogram for estimating disease free survival of node-positive penile cancer treated with surgery. Methods The clinieopathological data of 32 node-positive penile squamous cell carcinoma patients were retrospectively reviewed. All patients had undergone primary tumor excision and regional lymphadeneetomy. The pathological records showed that 10 were N1 , 13 were N2 and 9 were N3. Median level of preoperative squamous cell carcinoma antigen （SCCAg） was 0.9 μg/L. With a median follow-up of 16.5 months, 13 patients developed recurrence. Based on the stage, histological grade and preoperative serum squamous cell carcinoma antigen level, a nomogram was drawn on the basis of the Cox regression model. Results Stage and preoperative serum SCCAg levels were independent prognostic factors for disease free survival in node-positive penile cancer treated with surgery. The hazard ratio of SC- CAgleveland N stage was 2.76 （95% CI： 1.40 -5.44, P =0.0034） and 28.51 （95%C1：2.55 - 319.11, P=0. 0066）. The nomogram demonstarted good discrimination and calibration with a concordance index of 0. 855. Conclusions Based on the N stage and preoperative serum SCCAg level, a nomogram to predict disease free survival in node-positive penile cancer treated with surgery was set up. The prediction model could be helpful in predicting the risk of recurrence.