结肠神经内分泌肿瘤风险预测模型的建立与评估

Establishment and evaluation of risk prediction model for colonic neuroendocrine tumor

目的建立与评估可用于预测结肠神经内分泌肿瘤(NEN)风险的列线图模型。方法回顾性分析美国国立癌症研究所“监测、流行病学和结果数据库”(SEER数据库)2010年被诊断为结肠NEN的271例患者的临床资料,对所有患者13个相关因素进行单因素及多因素Cox比例危险回归模型分析,基于独立危险因素采用R软件构建列线图,并对该模型进行评估。结果结肠NEN患者的1年,3年和5年的生存率分别为84.09%(95%CI 79.74%-88.44%),76.66%(95%CI 71.60%-81.72%)和68.96%(95%CI 63.39%-74.53%);结肠NEN患者1年,3年和5年的肿瘤特异性生存率为89.08%(95%CI 85.32%-92.84%),85.43%(95%CI 81.14%-89.72%),81.06%(95%CI 76.20%-85.92%)。单因素和多因素COX回归分析结果显示,肿瘤分级、组织学类型、M分期和年龄是影响结肠NEN患者预后的独立危险因素。列线图一致性指数C-index(0.818,95%CI 0.778-0.860)显著高于传统TNM分期所构建模型的C-index(0.715,95%CI 0.657-0.756),预测性能良好。列线图的预测价值(AUC=0.858,95%CI 0.811-0.898)显著高于传统TNM分期(AUC=0.747,95%CI 0.691-0.798),差异具有统计学意义(Z=3.901,P=0.001)。结论基于肿瘤分级、组织学类型、M分期和年龄构建结肠NEN患者风险模型,为临床医师提供了精准预测患者预后的统计工具,有助于指导患者的治疗。

Objective To establish and evaluate a nomogram model for predicting the risk of colonic neuroendocrine tumor(NEN).Methods The clinical data of 271 patients diagnosed with colonic NEN in the SEER database in 2010 were retrospectively analyzed.The univariate and multivariate Cox proportional hazard regression models were analyzed for 13 related factors in all patients.The R-software was used to construct a nomogram based on independent risk factors and the nomogram model was evaluated.Results The 1-,3-,and 5-year survival rates of patients with colonic neuroendocrine tumors were 84.09%(95%CI 79.74%-88.44%),76.66%(95%CI 71.60%-81.72%)and 68.96%(95%CI 63.39%-74.53%)respectively.The 1-,3-,and 5-year cancer-specific survival rates of colonic neuroendocrine tumor patients were 89.08%(95%CI 85.32%-92.84%),85.43%(95%CI 81.14%-89.72%)and 81.06%(95%CI 76.20%-85.92%),respectively.Univariate and multivariate COX regression analysis showed that tumor grade,histological type,M stage and age were independent risk factors for the prognosis of patients with colonic neuroendocrine tumors.And the nomogram consistency index(0.818,95%CI 0.778-0.860)was significantly higher than that of the model constructed by the traditional TNM staging(0.715,95%CI 0.657-0.756),and the prediction performance was good.In addition,the predicted value of the nomogram(AUC=0.858,95%CI 0.811-0.898)was significantly higher than that of the traditional TNM staging(AUC=0.747,95%CI 0.691-0.798),and the difference was statistically significant(Z=3.901,P=0.001).Conclusion The risk model of colon NENs is constructed based on tumor grade,histology type,M stage and age,which provides a statistical tool for clinicians to accurately predict the prognosis of patients,and can help guide the treatment.