早期肺浸润型黏液腺癌的预后分析及预后模型的建立

Prognosis analysis of early pulmonary infiltration type mucinous adenocarcinoma and its prognostic model construction

目的对比Ⅰ期纯浸润性黏液腺癌(pIMA)与不同分化的肺腺癌的预后,并建立预后模型。方法从SEER数据库中纳入了322例Ⅰ期pIMA和3326例肺腺癌患者,经倾向性评分减少混杂偏倚后,Kaplan-Meier生存分析和亚组生存分析用来比较pIMA和肺腺癌患者的生存差异。为了进一步评估pIMA患者的预后,利用向前逐步比例风险(Cox)筛选与pIMA的总生存期(OS)相关的独立预后因素,将变量纳入Cox回归模型并使用列线图进行可视化分析。受试者工作特征曲线(ROC曲线)、校正曲线和临床决策曲线(DCA)对列线图进行准确度及临床实用度评价。结果经倾向性评分配对后的Kaplan-Meier生存分析结果显示Ⅰ期pIMA患者具有与Ⅰ期贴壁型腺癌(LA)相似的生存时间。亚组分析显示,在肺叶摘除术及右侧受累的亚组中,Ⅰ期pIMA患者拥有比LA更长的生存期。向前逐步Cox回归显示pIMA的独立预后因素包括年龄、性别、手术、胸膜浸润(VPI)和分化等级。ROC曲线、矫正曲线和DCA曲线显示Ⅰ期pIMA列线图具有很好的预测准确性及临床实用度。结论成功构建了可以精准预测Ⅰ期pIMA预后的列线图。

Objective To compare the prognosis between stage Ⅰ pure pulmonary infiltrative mucinous adenocarcinoma(pIMA) and different differentiations of pulmonary adenocarcinoma, and to establish a prognosis model.Methods A total of 322 cases of stage Ⅰ pIMA and 3 326 cases of pulmonary adenocarcinoma were included from the surveillance, epidemiology and end results(SEER) database.After the reducing the confounding bias by the propensity score, the Kaplan-Meier survival analysis and the subgroup survival analysis were used to compare the difference between the survivals of pIMA and the survivals of lung adenocarcinoma.For further assessing the prognosis of the patients with pIMA,the independent prognostic factors associated with the overall survival(OS) of pIMA were screened by using the forward stepwise proportional risk, the variables were included into the Cox regression model and the nomogram was used to conduct the visualized analysis(Cox).Then the receiver operating characteristic(ROC) curve, calibration curve and clinical decision curve analysis(DCA) were used to evaluate the accuracy degree and clinical practicality of the nomogram.Results After the propensity score matching, the Kaplan-Meier survival analysis results showed that the patients with stgaeⅠpTMA had the similar survival time to that of the patients with stageⅠadherent adenocarcinoma.The subgroup analysis showed that the patients with stage Ⅰ pIMA had a longer survival than those with LA in the subgroup of lobectomy and right involvement.The forward stepwise Cox regression showed that the independent prognostic factors of pIMA included the age, sex, operation, pleural infiltration(VPI) and differentiation grade.The ROC curve, correcting curve and DCA curve showed that the stage Ⅰ pIMA nomogram had very good predictive accuracy and practicality.Conclusion The nomogram precisely predicting the prognosis of stage ⅠpTMA is successfully constructed.