摘要
目的 探讨福建省口腔鳞状细胞癌(OSCC)患者预后影响因素并构建预后指数(PI)。方法 收集福建医科大学附属第一医院口腔颌面外科2004年1月至2016年6月经病理确诊634例OSCC患者的临床资料,并进行随访,将患者随机分为建立模型组(建模组,318例)和验证模型组(验证组,316例)。在建模组,运用Kaplan-Meier法计算生存率,log-rank检验比较生存率差别,采用Cox比例风险回归模型探讨OSCC患者预后影响因素并计算死亡风险比值(HR)及其95%CI,以模型组中有意义的预测变量的β值计算PI。运用三分位法将患者分为高危组、中危组和低危组,并在验证组中采用赤池信息准则(AIC)和Harrell一致性指数(Harrell's c-index,C)检验模型的预测效能。结果 Cox比例风险回归模型分析发现,OSCC患者中年龄≥ 55岁的HR值(95%CI)为2.22(1.45-3.39);口腔卫生较差的HR值(95%CI)为2.12(1.27-3.54);首诊淋巴结转移的HR值(95%CI)为5.78(3.60-9.27);TNM分期为Ⅲ-Ⅳ期(Ⅰ期为参照)的HR值(95%CI)为2.43(1.10-5.37);组织分化程度为低分化(高分化为参照)的HR值(95%CI)为2.53(1.60-4.01)。建模组和验证组中预后模型的预测效能良好(AIC和C值分别为1 205.80、0.700 2和1 150.47、0.737 3)。结论 年龄、口腔卫生、首诊断淋巴结转移、TNM分期和组织病理学分级是OSCC预后影响因素,构建PI模型可有效指导临床治疗。
Objective To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC).Methods From January 2004 to June 2016, a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian. The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC. All the patients were randomly divided into two groups:modeling group (modeling dataset, n=318) and validation group (validation dataset, n=316). Randomization was carried out by using computer-generated random numbers. In the modeling dataset, survival rates were calculated using Kaplan-Meier method and compared using the log-rank test. Cox regression model was used to estimate the hazard ratio (HRs) and 95% confidence intervals (CIs) of prognosis factors. An PI for OSCC patients prognostic prediction model was developed based on β value of each significant variable obtained from the multivariate Cox regression model. Using the tertile analysis, patients were divided into high-risk group, moderate-risk group, and low-risk group according to the PI, the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability.Results Results from the multivariate Cox regression model indicated that aged ≥ 55 years (HR=2.22, 95% CI:1.45-3.39), poor oral hygiene (HR=2.12, 95% CI:1.27-3.54), first diagnosis of lymph node metastasis (HR=5.78, 95% CI:3.60-9.27), TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (HR=2.43, 95% CI:1.10-5.37) and poor differentiation (well differentiation as reference) (HR=2.53, 95% CI:1.60-4.01) were the risk factors influencing the prognosis of OSCC. The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80, 0.700 2 and 1 150.47, 0.737 3).Conclusion Age, poor oral hygiene, first diagnosis of lymph node metastasis, TNM stage and histological grade were factors associated with the prognosis of OSCC, and the PI model has a certain significance in the clinical treatment of OSCC.
作者
伍俊锋
林李嵩
陈法
刘凤琼
鄢灵君
包晓丹
汪靖
王瑞
林亮坤
邱宇
郑晓燕
胡志坚
蔡琳
何保昌
Wu Junfeng;Lin Lisong;Chen Fa;Liu Fengqiong;Yan Lingjun;Bao Xiaodan;Wang Jing;Wang Rui;Lin Liangkun;Qiu Yu;Zheng Xiaoyan;Hu Zhijian;Cai Lin;He Baochang(Department of Epidemiology and Health Statistics, School of Public Health, Fufian Medical University, Fuzhou 350108, China;Department of Stomatology, The First Affiliated Hospital of Fufian Medical University, Fuzhou 350004, China)
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2018年第6期841-846,共6页
Chinese Journal of Epidemiology
基金
福建省科技厅科研项目(2015J01304)
福建省科技创新联合资金(2016Y9033)
福建省卫生计生科研人才培养项目(2017-ZQN-57)
关键词
口腔肿瘤
预后指数
COX回归
Oral carcinoma
Prognostic index
Cox regression