局部晚期口腔鳞状细胞癌根治性切除术后预后模型的构建

Development of a prognostic model for radical resection of locally⁃advanced oral squamous cell carcinoma

目的本研究旨在开发和验证可预测局部晚期口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)根治性切除术后患者预后的模型。方法共243例在2009年2月至2016年1月在我院接受根治性切除的原发性局部晚期OSCC患者被回顾性纳入分析。患者被随机分配至训练集(n=182)和验证集(n=61)。Cox回归在训练集中确定影响总生存期的(overall survival,OS)独立因素,用于开发预测3年和5年列线图模型和随机生存森林(random survival forest,RSF)模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线和决策曲线分析(decision curve analysis,DCA)评估预测模型的效能,并与AJCC分期系统进行比较。结果Cox回归显示年龄、KFI指数、pT分期、pN分期、AJCC分期、阳性淋巴结数、SII均是OS的独立预测因素(均P<0.05)。在验证集中,RSF模型、列线图模型、AJCC分期系统预测3年OS率的AUC分别为0.782、0.756、0.703,5年分别为0.780、0.731、0.696。校准曲线显示各预测模型有良好的一致性;DCA显示,列线图模型的临床价值高于AJCC分期,RSF模型的临床价值高于列线图模型。log⁃rank检验显示,RSF模型具有良好的危险分层能力(P<0.05)。结论基于年龄、KFI指数、pT分期、pN分期、AJCC分期、阳性淋巴结数、SII等构建的RSF模型可个体化预测根治性术后局部晚期OSCC患者的预后。

Objective To develop and validate a model that can predict the prognosis of patients with locally⁃advanced oral squamous cell carcinoma(OSCC)after radical resection.Methods A total of 243 patients with primary locally⁃advanced OSCC who underwent radical resection in our hospital from February 2009 to January 2016 were retrospectively analyzed.Patients were randomly assigned to the training set(n=182)and the validation set(n=61).Cox regression was used to determine the independent factors that affect the overall survival(OS)in the training set,and to develop predictive 3⁃year and 5⁃year nomogram models and random survival forest(RSF)models.The performance of the predictive model was evaluated by receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA),and compared with the AJCC staging system.Results Cox regression showed that age,KFI index,pT stage,pN stage,AJCC stage,the number of positive lymph nodes,and SII were independent predictors of OS(all P<0.05).In the validation set,the AUC of RSF model,nomogram model,and AJCC staging system for predicting 3⁃year OS rate were 0.782,0.756 and 0.703,respec⁃tively,for predicting 5⁃year OS rate were 0.780,0.731 and 0.696,respectively.The calibration curve showed that the prediction models had a good consistency;the DCA curve showed that the clinical value of the nomogram model was higher than that of the AJCC staging system,while the clinical value of the RSF model was higher than that of the nomogram model.The log⁃rank test showed that the RSF model had good risk stratification ability(P<0.05).Conclusions The RFS model constructed based on age,KFI index,pT staging,pN staging,AJCC staging,number of positive lymph nodes and SII,can individually predict the prognosis of patients with locally⁃advanced OSCC after curative surgery.