预测大肝癌患者预后的列线图:一项基于SEER数据库的研究

A nomogram to predict prognosis of patients with large hepatocellular carcinoma:a study based on SEER database

目的探讨大肝癌患者癌症特异生存的影响因素,并绘制列线图以预测患者的癌症特异生存率。方法检索SEER数据库中1975–2017年期间的大肝癌患者的临床病理数据,按1∶1随机分成训练组和验证组。采用训练组数据,以Cox比例风险回归模型探索癌症特异生存的影响因素并构建列线图;最后绘制受试者工作特征曲线(ROC曲线)和校准曲线对列线图进行内部验证和外部验证。结果多因素Cox比例风险回归模型结果显示,肝硬化程度、肿瘤分化程度、肿瘤直径、T分期、M分期、手术情况和化疗情况是影响大肝癌患者特异生存的独立影响因素(P<0.05),这些因素均纳入列线图用于预测癌症特异生存率。训练组的1、3和5年曲线下面积分别为0.800、0.827和0.814;验证组的1、3和5年曲线下面积分别为0.800、0.824和0.801;训练组的C指数为0.779,验证组为0.777。训练组与验证组的校正曲线接近理想的实际情况曲线。结论本研究绘制的预测模型列线图,在临床可用于预测大肝癌患者的特异生存。

Objective To explore the influencing factors of cancer-specific survival of patients with large hepatocellular carcinoma,and draw a nomogram to predict the cancer-specific survival rate of large hepatocellular carcinoma patients.Methods The clinicopathological data of patients with large hepatocellular carcinoma during the period from 1975 to 2017 in the Surveillance,Epidemiology,and End Results(SEER)database were searched and randomly divided into training group and validation group at 1∶1.Using the training data,the Cox proportional hazard regression model was used to explore the influencing factors of cancer-specific survival and construct the nomogram;finally,the receiver operating characteristic curve(ROC curve)and the calibration curve were drawn to verify the nomogram internally and externally.Results The results of the multivariate Cox proportional hazard regression model showed that the degree of liver cirrhosis,tumor differentiation,tumor diameter,T stage,M stage,surgery,and chemotherapy were independent influencing factors that affect the specific survival of patients with large hepatocellular carcinoma(P<0.05),and then these factors were enrolled into the nomogram of the prediction model.The areas under the1,3,and 5-year curves of the training group were 0.800,0.827,and 0.814,respectively;the areas under the 1,3,and 5-year curves of the validation group were 0.800,0.824,and 0.801,respectively.The C index of the training group was 0.779,and the verification group was 0.777.The calibration curve of the training group and the verification group was close to the ideal curve of the actual situation.Conclusion The nomogram of the prediction model drawn in this study can be used to predict the specific survival of patients with large hepatocellular carcinoma in the clinic.