基于SEER数据库的成人神经母细胞瘤临床特征及预后因素研究

Clinical character and prognostic factors in adult neuroblastoma based on SEER database

目的:利用来自SEER数据库中收纳的肿瘤流行病学数据,分析成年发病神经母细胞瘤(NB)的疾病特征和预后因素。方法:通过访问SEER数据库提取了其中1975-2016年病理确诊原发性NB病人的人群特征与疾病特征数据。根据确诊年龄将病人分为成人和青少年,通过竞争风险模型和Kaplan-Meier图对2组病人的生存率进行比较,并利用Cox回归模型识别成年病人特异的预后因素。依据多元回归模型绘制列线图辅助临床诊疗。结果:与青少年相比,成年病人预后较差(P<0.01)。成年NB病人的单变量回归提示确诊年龄≥50岁、行手术治疗、肿瘤原发灶部位为鼻咽部位、周围神经系统、组织学亚型、化疗情况均为预后相关因素(P<0.05~P<0.01)。校正后的多变量分析表明,年龄、手术、肿瘤原发灶部位对于病人生存率的影响均具有统计学意义(P<0.05~P<0.01)。建立的列线图用于预测成年NB病人3年和5年生存率,列线图的内部验证表明该预测方式可以区分高危与低危病人。结论:成年NB病人预后影响因素复杂多样,早期确诊和及时手术治疗可提高其生存率。

Objective:To analyze the disease characteristics and prognostic factors of adult neuroblastoma(NB)using tumor epidemiological data collected from the SEER database.Methods:We extracted data of primary NB patients diagnosed by positive histology during 1975-2016 from the SEER database.Patients were grouped into adults and adolescents according to the age of diagnosis.The competing-risk model and Kaplan-Meier plot were used to compare survival rates.Cox regression model was used to identify prognostic factors in adult patients.According to the multivariate model,a nomogram was developed to assist clinical diagnosis and treatment.Results:The prognosis of adult patients was worse than that of adolescents(P<0.01).Univariate analysis of adult NB revealed that age≥50 years old,surgical treatment,the primary tumor site of nasopharynx,peripheral nervous system,histological subtypes,and chemotherapy were all prognostic factors(P<0.05 to P<0.01).The adjusted multivariable analysis showed that age,surgery,and the location of the primary tumor had statistically significant effects on the survival rate of patients(P<0.05 to P<0.01).The established nomogram was used to predict the 3-year and 5-year survival rates of adult NB patients.The internal validation of the nomogram showed that the prediction method could distinguish high-risk patients from low-risk patients.Conclusions:The prognostic factors of adult patients with NB are complex and diverse.Early diagnosis and timely surgical treatment can improve their survival rate.