基于SEER数据库老年子宫内膜癌临床病理特征及预后列线图的构建与验证

The clinicopathological characteristics of elderly endometrial carcinoma and establishment and validation of prognostic nomogram based on the SEER database

目的 分析老年子宫内膜癌临床病理特征及预后风险因素,构建列线图并进行内部验证。方法 回顾性收集监测、流行病学和最终结果(SEER)数据库2010年至2019年符合条件的子宫内膜癌病例,分为≥60岁组和<60岁组,分析两组人群的临床病理特征。运用Cox比例风险回归模型进行单因素及多因素回归分析,探讨老年子宫内膜癌预后的风险因素,并构建其3、5年总生存率的列线图预测模型。通过一致性指数(C-index)、受试者工作特征(ROC)曲线及校准曲线评估列线图的可靠性。结果 共筛选21 446例患者,包括<60岁者8559例(39.91%),≥60岁者12 887例(60.09%)。两组人群在种族、病理类型、组织学分级、分期、手术方式、放疗、化疗、总生存率及癌症特异性生存率方面,差异均有统计学意义(P<0.05)。年龄、特殊病理类型(浆液性癌、混合型癌、癌肉瘤、透明细胞癌)、组织学分级、分期、手术方式、化疗及远处转移是影响老年子宫内膜癌患者预后的独立危险因素(P<0.05)。构建预测3、5年生存率的列线图,其C-index为0.839(95%CI:0.834~0.843)。列线图的校准曲线显示预测值和实际值具有较好的一致性。3、5年总生存率ROC曲线下面积(AUC)分别为0.864和0.847。结论 老年子宫内膜癌患者具有独特的临床病理学特征。以预后风险因素为基础构建的列线图,具有较好的一致性和准确度,可作为判断预后和指导治疗的参考。

Objective To analyze the clinicopathological characteristics and prognostic risk factors of endometrial carcinoma in the elderly,construct a nomogram and verify it.Methods The retrospective cohort study was conducted.The eligible endometrial cancer cases from 2010 to 2019 in the Surveillance,Epidemiology and End Result(SEER)database were collected.All cases were divided into two groups(age≥60,age<60),and the differences of clinical and pathological characteristics were analyzed.Cox regression analysis was used to explore the prognostic risk factors of endometrial cancer in the elderly.On this basis,a prognostic nomogram model for predicting 3-year and 5-year overall survival rates was constructed and validated internally,and its reliability was evaluated by the consistency index(C-index),receiver operating characteristic(ROC)curve and calibration curve.Results A total of 21446 patients were screened,including 8559 patients(39.91%)under 60 years old and 12887 patients(60.09%)over 60 years old.There were significant differences between the two groups in terms of race,pathological type,histological grade,stage,operation mode,radiotherapy,chemotherapy,overall survival rate and cancer specific survival rate(P<0.05).Age,special pathological type(serous carcinoma,mixed carcinoma,carcinosarcoma,clear cell carcinoma),grade,stage,operation mode,chemotherapy and distant metastasis were independent risk factors of elderly endometrial carcinoma(P<0.05).A nomogram was constructed,the predicted C-indices for overall survival was 0.839(95%CI:0.834-0.843).The area under the curve of ROC of 3-year and 5-year overall survival rates were 0.864 and 0.847 respectively.Conclusion The elderly endometrial carcinoma had unique clinicopathological characteristics.The nomogram based on prognostic risk factors has good consistency and accuracy,which can be used as a reference to judge prognosis and guide treatment.