胃癌多器官转移患者列线图预测模型构建

Establishment of a Nomogram Prediction Model for Gastric Cancer Patients with Multi-organ Metastases

目的通过探究胃癌多器官转移患者预后影响因素,构建并验证预测患者预后的列线图模型。方法通过SEER数据库收集2010~2018年胃癌多器官转移患者的临床资料,使用R软件随机分为训练组和验证组。采用COX等比例风险模型筛选出影响患者预后的独立危险因素,并在此基础上构建列线图预测模型。通过一致性指数(C-index)及校准曲线评估预测模型的可靠性和准确性。结果本研究共纳入1342例胃癌多器官转移患者病例,按照7∶3的比例随机划分为训练组(n=942)和验证组(n=400)。COX多因素分析结果显示,年龄、原发部位、转移情况、肿瘤直径、分化程度及转移灶手术是胃癌多器官转移患者预后的独立危险因素(P均<0.05),并基于上述因素成功构建列线图预测模型。在预测模型中训练组及验证组的C-index分别为0.604(95%CI:0.580~0.628)和0.612(95%CI:0.577~0.647)。通过绘制预测模型的校准曲线发现列线图的预测曲线和理想曲线拟合良好,说明所构建模型的校准度较高。结论基于SEER数据库建立的预测胃癌多器官转移患者预后的列线图模型具有良好的预测价值,有助于临床医生制定准确的个体化治疗方案。

Objective To construct and validate a nomogram model for predicting the prognosis of patients by exploring the prognostic factors of gastric cancer patients with multi-organ metastases.Methods The clinical data of gastric cancer patients with multi-organ metastases from 2010 to 2018 were collected by SEER database and randomly divided into training cohort and validation cohort using R software.The COX equal proportion risk model was used to screen out the independent risk factors affecting the prognosis of patients,and a nomogram prediction model was built on this basis.The reliability and accuracy of the prediction model were evaluated by consistency index(C-index)and calibration curve.Results A total of 1342 gastric cancer patients with multi-organ metastases were included in this study and randomly divided into the training cohort(942 cases)and the validation cohort(400 cases)in a 7∶3 ratio.COX multivariate analysis results showed that age,primary site,metastases,tumor size,degree of differentiation and metastatic surgery were independent risk factors in gastric cancer patients with multi-organ metastases(P<0.05),and the nomogram prediction model was constructed based on the above factors.In the prediction model,the C-index of the training cohort and the validation cohort were 0.604(95%CI:0.580-0.628)and 0.612(95%CI:0.577-0.647).The calibration curve found that the predicted curve and the ideal curve fit well,indicating that the built model had high calibration degree.Conclusion Based on the SEER database,this study established and validated the nomogram model for gastric cancer patients with multi-organ metastases,which helped clinicians to formulate accurate and individualized treatment plans.