进展期胃癌根治术后5年预后因素分析及生存预测模型的建立

Analysis of prognostic factors and establishment of predictive model for predicting 5-year survival of advanced gastric cancer after radical surgery

目的建立影响进展期胃癌根治术后5年生存情况的预测指数(predict index,PI)模型,评价该模型的预测价值。方法对所有相关影响因素进行Kaplan-Meier和Log-rank单因素分析和多因素Cox回归分析,得出预测因子及回归系数,根据预测因子及回归系数建立PI模型,对PI模型进行有效性检验和多因素校正,绘制PI模型预测进展期胃癌术后5年生存情况的ROC曲线,评价该模型对于判断进展期胃癌术后5年生存情况的预测价值。结果根据独立预测因子及回归系数建立PI模型:PI=0.13×X1(岁)+0.35×X2(分化型=0,未分化型=1)+0.58×X3(否=0,是=1)+0.78×X4(Ⅰ期=1,Ⅱ期=2,Ⅲ~Ⅳ期=3)+0.39×X5(否=0,是=1),PI的临界值为7.63,模型有效性经卡方检验得出χ2=15.48,P<0.05,PI模型经多因素校正,成为独立预测因子:PI(β=1.06,OR=2.82),PI模型的受试者工作特征曲线下面积(AUROC)为0.793(0.772~0.932),准确度为80.0%。结论本研究首次提出了关于判断进展期胃癌根治术后5年生存情况的预测模型,该模型的预测价值较高,为临床对进展期胃癌根治术后5年生存情况的精准评估和预后的判断提供了有力的依据。

Objective To establish a predict index(PI)model for predicting 5-year survival of advanced gastric cancer after radical gastrectomy,and to evaluate the predictive value of the model.Methods The Kaplan-Meier and Log-rank univariate analysis and multivariate Cox regression analysis were used to analyze all the related factors,then the predictive factors and regression coefficients were obtained.Based on the predictive factors and regression coefficients,PI model was established.The validity of PI model was tested and multivariate calibration was made.The ROC curve of PI model for predicting 5-year survival of advanced gastric cancer after radical surgery was drawn,to evaluate the predictive value of this model in predicting 5-year survival of patients with advanced gastric cancer after radical surgery.Results Independent predictive factors and their regression coefficients were used to establish PI model and it was expressed as:PI=0.13×X1(age)+0.35×X2(differentiation type=0,undifferentiated type=1)+0.58×X3(No=0,Yes=1)+0.78×X4(Ⅰstage=1,Ⅱstage=2,Ⅲ-Ⅳstage=3)+0.39×X5(No=0,Yes=1).The cut-off value of PI was 7.63.The validity of PI model was tested,χ2=15.48,P<0.05,after multi-factor correction,PI(β=1.06,OR=2.82)was the independent predictor.The area under ROC(AUROC)of PI model was 0.793(0.772-0.932),and the accuracy was 80.0%.Conclusion Our study is the first to put forward a predictive model for predicting 5-year survival of advanced gastric cancer after radical resection.The predictive value of this model is high.It provides a strong basis for clinical accurate assessment of 5-year survival and prognosis of advanced gastric cancer after radical resection.