基于SEER数据库构建三阳性乳腺癌总生存率的列线图

Construction of nomogram of overall survival rate of triple positive breast cancer based on SEER database

目的构建影响三阳性乳腺癌(TPBC)总生存的列线图,建立生存风险预测模型。方法在美国肿瘤监测、流行病学和最终结果(SEER)数据库中收集2010-2015年确诊并接受系统治疗的雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER2)均表达阳性的TPBC,随机分为训练集和验证集。在训练集中,用多因素Cox回归筛选影响总生存的预后因素,并绘制TPBC总生存率列线图,利用一致性指数(C-index)和校正曲线对预测模型进行内部验证,通过验证集的内部验证,验证列线图的准确性。结果共纳入11811例TPBC患者,按照7∶3的比例,通过随机分组的方式将其分为训练集8271例和验证集3540例。结果显示,年龄和TNM分期是影响TPBC总生存的独立因素,训练集和验证集的C-index分别为0.797(95%CI为0.785~0.809)和0.801(95%CI为0.781~0.821)。校正曲线中3和5年生存率都接近45°,证明列线图具有良好的预测TPBC总生存率的作用。结论建立的列线图显示年龄和肿瘤TNM分期是影响TPBC预后的独立因素,列线图能够很好地预测TPBC的生存率,对临床中预测TPBC的预后可以提供一定的参考。

Objective To construct the nomogram of influencing the overall survival of triple positive breast cancer(TPBC)and establish the survival risk prediction model.Methods TPBC with positive expression of estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor-2(HER2)diagnosed and received systematic treatment from 2010 to 2015 were collected in surveillance,epidemiology,and end results(SEER)database and randomly divided into training set and validation set.In the training set group,multivariate Cox regression was used to screen the prognostic factors affecting the overall survival,and a nomograph of TPBC overall survival rate was drawn.The prediction model was internally validated using the consistency index(C-index)and correction curve.The accuracy of the nomograph was verified through the internal validation of the validation set.Results A total of 11811 TPBC were enrolled in this study.According to the ratio of 7∶3,they were randomly divided into training set(8271 cases)and verification set(3540 cases).The results showed that age and TNM stage were independent factors affecting the total survival of TPBC.The C-index of training set and verification set were 0.797(95%CI:0.785-0.809)and 0.801(95%CI:0.781-0.821),respectively.The 3-year and 5-year survival rates in the calibration curve were close to 45°,which proved that the nomogram had a good role in predicting the overall survival rate of TPBC.Conclusions The nomogram established in this study shows that age and tumor TNM stage are independent factors affecting the prognosis of TPBC.The nomogram constructed in this study can well predict the survival rate of TPBC,and can provide some reference for predicting the prognosis of TPBC in clinical practice.