基于SII、NLR建立预测胃癌术后患者预后列线图

Nomogram for predicting postoperative prognosis of gastric cancer patients based on SII and NLR

目的:评价根据术前外周血系统性免疫炎症指数(systemic immune inflammation index,SII)、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)构建的列线图模型对胃癌根治术后患者预后的预测价值。方法:323例胃癌术后患者以7∶3比例随机分为训练组和验证组。使用X-Tile软件计算SII和NLR的最佳临界值,据此分为高、低两组,采用单因素和多因素回归分析来评估SII和NLR的预后价值,并以此构建预测患者总生存期(overall survival,OS)和无进展生存期(progression-free survival,PFS)的列线图。一致性指数(consistency index,C-index)、绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)和校准曲线与传统TNM分期比较,及决策曲线(decision curve analysis,DCA)用以评价模型。结果:筛选出包括SII和PLR在内的6个独立危险因素(P<0.05);预测总生存期(OS)的列线图C-index为训练集(0.804,95%CI:0.786~0.822)和验证集(0.780,95%CI:0.746~0.814),预测无进展生存期(PFS)列线图的C-index分别为训练集(0.806,95%CI:0.787~0.823)和验证集(0.778,95%CI:0.746~0.810),均明显高于TNM分期。ROC和校准曲线结果显示列线图模型在OS和PFS方面均具有较高的预测准确性;DCA显示该模型具有良好的临床净收益。结论:SII和NLR是影响胃癌根治术后患者预后独立影响因素。SII和NLR构建的列线图模型对胃癌根治术后患者预后具有较高的预测价值。

Objective:To evaluate the prognostic value of the nomogram model which corporates the preoperative systemic immune inflammation index(SII)and neutrophil to lymphocyte ratio(NLR)in patients with gastric cancer who received radical gastrectomy.Methods:According to 7∶3 radio,323 GC patients were randomly divided into training cohort and validation cohort.The optimal cut-off values for SII and NLR were calculated by X-Tile software,patients were divided into high and low groups according to the cut-off values.Univariate and multivariate regression analysis were performed to construct the nomogram which forecast the overall survival(OS)and the progression-free survival(PFS)of patients.The nomogram and the TNM staging system were compared by C-index,ROC,calibration curves and DCA were used to evaluate the dynamic nomogram.Results:6 independent risk factors were filtered including SII and PLR(P<0.05).C-index of OS nomogram(training cohort:0.804,95%CI:0.786~0.822,validation cohort:0.780,95%CI:0.746~0.814),C-index of PFS nomogram(training cohort:0.806,95%CI:0.787~0.823,validation cohort:0.778,95%CI:0.746~0.810),suggested that the nomogram performed better than the traditional TNM staging system.The ROC,calibration curves and DCA also indicated the clinical effectiveness of the model.Conclusion:SII and NLR are independent influencing factors of patients with gastric cancer who received radical gastrectomy.The nomogram model constructed based on SII and NLR provides higher predictive value for the prognosis of patients after radical gastrectomy.