成釉细胞瘤预后评估——基于SEER数据库的研究

Prognosis evaluation of ameloblastoma—A study based on SEER database

目的成釉细胞瘤(AM)是罕见牙源性肿瘤,易复发、浸润生长,本研究旨在探讨成釉细胞瘤预后因素。方法基于SEER数据库筛选成釉细胞瘤207例,构建Cox回归模型并绘制诺莫图预测总生存。回顾性分析湖南省肿瘤医院61例临床资料,用Cox回归分析影响复发的独立因素。结果基于SEER数据库评估,年龄、肿瘤大小、手术方式、放疗均是影响AM患者总生存的重要因素,构建列线图,一致性指数为0.821,表明预测模型具有中等准确度。受试者工作曲线显示1、3、5、10年的曲线下面积分别为0.852、0.869、0.856、0.879,表明预测模型具有较好的敏感性和特异性。Kaplan-Meier生存分析显示高风险组总生存低于低风险组(P<0.001)。基于回顾性分析,临床症状、手术类型是影响局部复发率的独立因素;面部肿痛,相对于其他症状复发率更低,根治手术相对于姑息手术可降低复发率。结论年龄、肿瘤大小、手术方式、放疗可能是影响总生存的重要因素;手术方式、临床症状可能是影响复发率的独立因素。

Objective Ameloblastoma(AM)is a rare tumor derived from dental epithelial tissues,which is prone to recurrence and infiltration.This study aims to identify the prognostic factors of AM.Methods 207 ameloblastoma patients were screened from the SEER database.A Cox regression model and nomogram were constructed to evaluate the factors on the overall survival.Clinical data of 61 patients admitted to Hunan Cancer Hospital were retrospectively analyzed.The independent factors of recurrence rate were analyzed by the Cox regression model.Results The results on the SEER database showed that age,tumor size,type of surgery,radiotherapy were important prognostic factors of the overall survival.The nomogram was constructed and the C-index was equaled to 0.821,indicating this model was moderately accurate.The receiver operating characteristic(ROC)curve demonstrated that the area under the ROC curve(AUC)at 1,3,5,and 10 years were 0.852,0.869,0.856,and 0.879,indicating this model had relatively high sensitivity and specificity.Kaplan-Meier survival analysis suggested that overall survival in the high-risk group was significantly lower than that in the low-risk group(P<0.001).Based on retrospective analysis,clinical symptoms and type of surgery were the independent factors of the local recurrence rate.Kaplan-Meier survival analysis found the recurrence rate of facial swelling and pain was lower compared to those of other symptoms.Compared with the palliative surgery,radical surgery could decrease the recurrence rate.Conclusions Age,tumor size,type of surgery,and radiotherapy may be important factors of the overall survival.Type of surgery and clinical symptoms are probably the independent factors of the recurrence rate.