甲状腺癌患者预后列线图的构建及验证

Construction and validation of prognostic nomograms of patients with thyroid cancer

目的利用甲状腺癌患者预后独立因素构建预后列线图并进行验证。方法从美国国立癌症研究所监测、流行病学和最终结果(SEER)数据库收集2004—2015年诊断为甲状腺癌的94216例患者的临床资料,采用随机数字表法分为训练组(n=47108)和内部验证组(n=47108),选取2008—2020年于武汉科技大学附属孝感医院诊断为甲状腺癌的1500例患者作为外部验证组。采用Cox比例风险回归模型分析甲状腺癌患者总生存率的影响因素并构建预后列线图,预测10、15、20年总生存率,计算一致性指数(c-指数),通过校准曲线确定列线图预测的准确性。结果单因素分析结果显示,年龄、性别、肿瘤直径、区域淋巴结转移状态、远处转移状态、临床TNM分期、病理类型、原发灶手术状态、区域淋巴结手术状态、放疗状态、婚姻状态均可能是甲状腺癌患者总生存率的影响因素(P﹤0.01)。多因素分析结果显示,年龄≥55岁、男性、肿瘤直径﹥39 mm、区域淋巴结转移、远处转移、临床TNM分期为Ⅱ/Ⅲ/Ⅳ期、病理类型为髓样癌及未分化癌、原发灶未进行手术、区域淋巴结未手术、未进行放疗、离婚/丧偶均是甲状腺癌患者总生存率的独立危险因素(P﹤0.05)。基于影响因素构建10、15、20年总生存率的列线图并进行内外部验证,训练组c-指数为0.855(95%CI:0.846~0.864),内部验证组c-指数为0.851(95%CI:0.842~0.860),外部验证组c-指数为0.812(95%CI:0.759~0.865),校准曲线表明了列线图预测总生存率与实际总生存率具有良好的一致性。结论甲状腺癌患者总生存率列线图能够比较准确地预测10年总生存率,有助于临床医师对甲状腺癌患者进行个体化的预后评估及治疗策略制订。

Objective To develop and validata prognostic nomogram by independent prognostic factors of patients with thyroid cancer. Method The clinicopathological characteristics of 94 216 patients diagnosed with thyroid cancer was collected from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. All patients were randomly divided into training group(47 108 cases) and internal verification group(47 108 cases) by random number grouping, 1500 patients diagnosed with thyroid cancer in Xiaogan Hospital Affiliated Wuhan University of Science and Technology between 2008 and 2020 served as an external verification group. Cox regression model was used to identify independent prognostic factors and construct a prognostic nomogram, predicting 10-year, 15-year and 20-yera overall survival rates. Consistency index(c-index) and calibration curve defined the prediction accuracy and discriminative power of the nomogram. Result Univariate analysis showed that age, gender, tumor diameter, regional lymph node metastasis status,distant metastasis status, clinical TNM stage, pathological type, primary tumor operation status, regional lymph node operation status, radiotherapy status and marital status may be the influencing factors of survival rate of patients with thyroid cancer(P<0.01). Multivariate analysis showed that age≥ 55 years old, male, tumor diameter>39 mm, regional lymph node metastasis, distant metastasis, clinical TNM stage Ⅱ/Ⅲ/Ⅳ, pathological type of medullary carcinoma and undifferentiated carcinoma, primary tumor without operation, regional lymph node without operation, radiotherapy, divorce/widowed were risk factors for survival rate of patients with thyroid cancer(P<0.05). Based on independent prognostic factors, the10-year, 15-year, 20-year nomogram of overall survival rate was constructed and internally and externally verified. The c-index of training group was 0.855(95%CI: 0.846-0.864), the c-index of internal validation group was 0.851(95%CI:0.842-0.860), and the c-index of external validation group was 0.812(95% CI: 0.759-0.865). The calibration curve showed that the predicted survival rate of the nomogram was in good agreement with the actual survival rate. Conclusion The nomogram of overall survival rate of patients with thyroid cancer can accurately predict 10-year survival rates, which is helpful for clinicians to make individualized prognostic evaluation and treatment strategies for patients.