肾集合管癌预后列线图的建立

Development of nomogram for predicting the prognosis of patients with renal collecting duct carcinoma

目的建立肾集合管癌(CDC,又称Bellini管癌)预后列线图。方法从美国国立癌症研究所的监测、流行病学和结局数据库中筛选出282例经病理证实为CDC的患者临床资料,采用随机数字表法,按7:3的比例分为训练队列186例和验证队列96例。在训练队列中,使用单因素和Cox多因素生存回归模型分析影响患者预后的因素,确定最优预测模型并建立预后列线图,评估预测效能。在验证队列中,采用ROC曲线和校准曲线验证列线图的准确度。采用决策曲线分析列线图的临床适用性。结果年龄、TNM分期、肿瘤直径、原发病灶是否手术、是否行化疗是CDC患者的独立预后因素,并纳入列线图的构建。在训练队列或验证队列中,ROC曲线及校准曲线分析显示,所建立的预后列线图具有较好的预测准确度(均AUC>0.7),且列线图预测的生存率与实际生存率具有较好的一致性。决策曲线分析显示所建立的列线图在CDC患者预后预测方面具有潜在的临床适用性。本研究所建立的CDC预后列线图可通过https://chingfeng.shinyapps.io/DynNomappCDC/在线访问并使用。结论本研究所建立的CDC预后列线图(包括年龄、TNM分期、肿瘤直径、原发病灶是否手术、是否行化疗等因素)具有较高的预测效能及临床适用性。

Objective To establish a prognostic nomogram for patients with renal collecting duct carcinoma(CDC).Methods Clinical data of 282 patients with pathologically confirmed renal CDC were extracted from the SEER database.The patients were divided into training cohort(186 cases)and verification one(96 cases)according to the random number table.Univariate and multivariate Cox regression analyses were performed in the training cohort to analyze the prognostic factors of CDC,the optimal prediction model was selected and the prognostic nomogram was established.The accuracy of the nomogram was tested through AUC of ROC and calibration curve.The clinical applicability of the nomogram was verified through the decision curve analysis(DCA).Results Age,TNM stage,tumor size,operation for primary lesions and chemotherapy were significant prognostic factors of CDC,which were used to develop the predicting nomogram.ROC curves of both cohorts demonstrated the prediction accuracy of the established nomogram(all AUC>0.7)and the calibration curves showed the consistency between the predicted survival and the real survival of patients.DCA confirmed the potential clinical practicality of the nomogram in prediction of CDC survival.An online Web server(https://chingfeng.shinyapps.io/DynNomappCDC/)was constructed based on the nomogram to facilitate clinical application.Conclusion The prognostic nomogram of CDC developed in this study is based on factors of age,TNM stage,tumor size,the operation for primary lesions and chemotherapy,which has certain prognostic value and clinical practicality for patients with renal collecting duct carcinoma.