基于SEER数据库构建老年鼻咽癌患者生存预后列线图

Construction of survival and prognosis nomogram for elderly nasopharyngeal carcinoma(≥60 years)based on SEER Database

目的利用美国流行病学监测和结果(surveillance,epidemiology,and end results,SEER)数据库构建老年鼻咽癌患者(≥60岁)生存预后风险预测列线图,预测老年鼻咽癌患者的总生存率,为临床决策提供科学依据。方法从数据库中提取2004—2015年期间的老年鼻咽癌患者共1366例,随机分为建模组和验证组。对建模组采用Cox比例风险回归模型分析患者的预后影响因素,再构建列线图。利用一致性指数(C-index)和校正曲线对列线图进行验证,评估其预测价值。结果建模组的Cox比例风险回归模型结果表明:年龄、婚姻、种族、肿瘤分化等级、组织学类型、TNM分期及放化疗均是老年鼻咽癌患者的预后影响因素(均P<0.05),均被用于构建风险预测列线图。风险预测列线图的验证结果表明,建模组的C指数为0.732(95%CI为0.708~0.756),验证组为0.762(95%CI为0.729~0.795);2组的校正曲线均表现出良好的一致性。结论本研究构建的老年鼻咽癌患者生存预后的风险预测列线图具有良好的预测价值,可快速准确对患者进行个体化的生存预后评估;有远处转移的80岁以上鼻咽癌患者或许是预立医疗照护计划的切入点。

Objective To establish a nomogram to predict the overall survival(OS)rate of elderly patients with nasopharyngeal carcinoma(≥60 years)by utilising the database of the Surveillance,Epidemiology and End Results(SEER)program.Methods The data of 1366 elderly patients with nasopharyngeal carcinoma who were diagnosed between 2004 and 2015 from the SEER database were obtained.These patients were randomly divided into training(n=954)and validation(n=412)cohorts.The Cox Proportional hazards regression model was performed to evaluate the prognostic effects of multiple clinicopathologic factors on OS.Significant prognostic factors were combined to build a nomogram.The predictive performance of the nomogram was evaluated via internal(training cohort data)and external validation(validation cohort data)by calculating the index of concordance(C-index)and plotting calibration curves.Results In the training cohort,the results of Cox proportional hazards regression model showed that age at diagnosis,married status,race,grade,histologic type,TNM stage,radiation and chemotherapy were significantly associated with the survival prognosis(P<0.05).These factors were used to establish the nomogram.The nomogram showed good accuracy in predicting OS rate,with a C-index of 0.732(95%CI:0.708-0.756)in internal validation and a C-index of 0.762(95%CI was 0.729-0.795)in external validation.All calibration curves showed excellent consistency between prediction by nomogram and actual observation.Conclusion A novel nomogram for elderly patients with nasopharyngeal carcinoma is established to predict OS in our study and shows good prognostic significance.It can provide medical personnel with accurate and practical predictive tools which can quickly and accurately assess the survival prognosis of patients individually and guide medical personnel in the follow-up treatment of patients.