Wilms瘤患儿生存预后影响因素分析及预测列线图的构建

Analysis of prognostic factors in children with Wilms tumor and construction of predictive nomogram

目的分析Wilms瘤患儿生存预后的影响因素并构建预测列线图。方法回顾性分析本院186例Wilms瘤患儿的临床资料及预后资料。用Cox比例风险回归模型分析影响患儿总体生存期的因素,通过所得因素用R3.5.1软件的rms安装包绘制出列线图,用Bootstrap自抽样法进行内部验证,通过一致性指数(C-index)评估列线图对Wilms瘤患儿生存预测的准确性。绘制ROC曲线分析列线图模型预测Wilms瘤患儿生存预后的价值,计算ROC曲线下面积(AUC)。结果186例患儿均得到有效随访,3年生存率和5年生存率分别为74.7%和72.0%。Cox多因素分析结果显示,年龄(OR=1.745)、发病部位(OR=1.886)、肿瘤大小(OR=2.290)、COG分期(OR=2.340)和病理分型(OR=0.375)是影响Wilms瘤患儿生存预后的独立因素(P均<0.05)。用上述5个因子绘制列线图,C-index为0.741。3年总体生存率和5年总体生存率的列线图校准曲线接近45°对角线,提示列线图预测生存率与实际生存率较为接近。列线图预测3年死亡预后的AUC为0.835(95%CI:0.811~0.921),预测5年死亡预后的AUC为0.818(95%CI:0.802~0.917)。结论年龄、发病部位、肿瘤大小、COG分期是影响Wilms瘤患儿生存预后的独立因素,根据上述因素构建的列线图可较为准确地预测Wilms瘤患儿的生存预后。

Objective To analyze the prognostic factors in children with Wilms tumor and construct the predictive nomogram.Methods The clinical data and prognosis of 186 cases of Wilms tumor in Tangshan Maternal and Child Health hospital were analyzed retrospectively.Cox proportional hazard regression model was used to analyze the factors affecting the overall survival of children.The nomogram was drawn with rms package of R3.5.1 software.Bootstrap self sampling method was used for internal verification.The accuracy of nomogram in predicting survival of children with Wilms tumor was evaluated by c-index.ROC curve was drawn to analyze the value of nomogram model in predicting the survival and prognosis of Wilms tumor children,and the area under the ROC curve(AUC)was calculated.Results All 186 children were followed up effectively,and the 3-year and 5-year survival rates were 74.7%and 72.0%,respectively.Cox multivariate analysis showed that age(OR=1.745),location of disease(OR=1.886),tumor size(OR=2.290),COG staging(OR=2.340)and pathological classification(OR=0.375)are independent factors that affect the prognosis of children with Wilms tumor(all P<0.05).Use the above 5 factors to draw a nomogram,and the C-index is 0.741.The calibration curve of the nomogram for the 3-year overall survival rate and the 5-year overall survival rate is close to the 45°diagonal,which indicates that the nomogram predicts survival rate and actual survival rate is relatively close.The AUC of nomogram predicting 3-year death prognosis is 0.835(95%CI:0.811~0.921),and the AUC of nomogram predicting 5-year death prognosis is 0.818(95%CI:0.802~0.917).Conclusions Age,location,tumor size,COG staging are independent factors that affect the survival and prognosis of children with Wilms tumor.The nomogram constructed based on the above factors can predict the survival and prognosis of children with Wilms tumor accurately.