可切除的肢端黑色素瘤预后影响因素分析及预测模型建立

Analysis of Prognostic Factors and Development of Prognostic Model for Resectable Acral Melanoma Patients

【目的】探讨影响可切除的肢端黑色素瘤患者预后的危险因素,建立预测模型并验证其预测价值。【方法】回顾性分析2001年1月至2011年8月在中山大学肿瘤防治中心接受根治性手术切除的232例肢端黑色素瘤患者的临床病理特征及术前炎症指标,应用COX比例风险回归模型分析预后影响因素并在此基础上建立预测模型,采用Kaplan-Meier法绘制生存曲线并对组间差异进行log-rank检验,通过ROC曲线下面积(AUC)评价模型的预测准确度。【结果】通过COX比例风险回归模型分析显示年龄、LDH、肿瘤分期、球蛋白、CRP为影响患者预后的独立危险因素。根据回归系数β对以上五项因素赋值并计算每位患者的总评分,按照不同评分进行危险分级:低危组(0-2分)、中危组(3-5分)、高危组(6-9分),三组的5年总生存率分别为42.9%、25.7%和3.7%,各组的预后具有明显统计学差异(P<0.001),预测模型ROC曲线下面积AUC:0.664(95%CI:0.599-0.724)。【结论】年龄、LDH、肿瘤分期及术前的球蛋白和CRP水平是影响可切除的肢端黑色素瘤患者预后的独立危险因素。新建立的预测模型能够较好的反应肢端黑色素瘤患者的预后,并且可对不同分期的患者按照危险度加以区分,是对TNM分期的有益补充,为临床进行分层个体化治疗和预后预测提供参考。

【Objective】To analyze the prognostic factors of resectable acral melanoma patients,then develop a novel prognostic model and examined its prognostic value.【Methods】The study retrospectively analyzed clinicopathological characteristics and inflammatory markers of 232 acral melanoma patients who underwent radical surgical resection between 2000 and 2011 at the Sun Yat-sen University Cancer Center.Kaplan-Meier curves were plotted to estimate overall survival.Significantly predictive factors were identified by multivariate Cox regression analyses and a prognostic model based on these variables was constructed to predict survival.【Results】Cox regression analysis revealed that age,lactic dehydrogenase（LDH）,stage,globulin（GLB）and C-reactive protein（CRP）were independently related to survival.After computing these scores,patients were classified into three risk groups.The new prognostic model identified three categories of patients with different prognoses（P0.001）and significantly stratify patient prognosis in different tumor stages.The 5-year survival rate was 42.9%,25.7%,and 3.7% in groups 1,2,and 3,respectively.The AUC of new prognostic model is 0.664（95% CI：0.599-0.724）.【Conclusion】Age,LDH,stage,GLB and CRP were independently related to survival in our study population,and the prognostic model is useful to stratify patients into different risk groups and it is a useful complement to AJCC staging for Asian patients with acral melanoma.