基于治疗前常规临床指标的鼻咽癌预后模型构建

Preliminary study for building pretreatment prognostic model based on routine clinical indicators in nasopharyngeal carcinoma

目的探讨治疗前常规临床指标对鼻咽癌患者总生存的预测价值,寻找可用于构建鼻咽癌预后模型的常规临床指标。方法纳入接受根治性放疗的初治鼻咽癌患者301例。用受试者工作特征曲线获得患者治疗前各常规临床指标预测总生存的分组界值,用Kaplan-Meier曲线进行单因素生存分析,用多因素Cox比例风险模型确定影响总生存的独立预后因素。结果单因素生存分析发现:男性、年龄>42岁、理想体重百分比≤98.7%、体质指数≤22.6 kg/m^(2)、血红蛋白≤122 g/L、血清白蛋白≤43 g/L、碱性磷酸酶>76 U/L、T3~4期、N2~3期为总生存的不良预后因素。Cox模型多因素生存分析发现:性别、年龄、T分期、N分期、血红蛋白水平、理想体重百分比、白蛋白水平等治疗前指标是影响鼻咽癌总生存的独立预后因素。结论可依据性别、年龄、理想体重百分比、T分期、N分期、血红蛋白水平、白蛋白水平等治疗前常规指标构建鼻咽癌预后模型。

Objective To investigate the independent prognostic indicators of overall survival(OS)from the pretreatment routine clinical examinations of NPC patients,and to find out the factors used for constructing pretreatment prognosis model.Methods A total of 301 patients with newly diagnosed NPC who received radical radiotherapy were enrolled into analysis.The receiver operating characteristic(ROC)curve was used to obtain the grouping threshold;Kaplan-Meier methods and log-rank test were applied for univariate survival comparisons;Cox proportional hazards model was used to identify the independent prognostic factors for OS.Results Univariate survival analysis found that male,age>42-year-old,ideal body weight percentage(IBW%)≤98.7%,body mass index(BMI)≤22.6 kg/m^(2),hemoglobin(Hb)≤122 g/L,serum albumin(ALB)≤43 g/L,alkaline phosphatase(ALP)>76 U/L,T3-4 and N2-3 were poor prognostic factors for OS.Multivariate survival analysis identified gender,age,T stage,N stage,IBW%,hemoglobin level and albumin level were the independent prognostic factors for OS.Conclusion The pretreatment routine clinical indicators,including gender,age,IBW%,T stage,N stage,hemoglobin level and albumin level,could be used as prognostic indicators to construct a prediction model for NPC patients.