口腔鳞状细胞癌列线图预后模型建立与评估

Establishment and evaluation of the nomogram prognostic model for oral squamous cell carcinoma

目的:探讨口腔鳞状细胞癌(OSCC)患者预后相关因素,建立列图预测模型,对OSCC患者总生存时间(OS)及无病生存时间(DFS)进行评估。方法:回顾性分析361例口腔鳞癌患者的临床病理资料,采用Log-rank检验及COX模型单因素及多因素分析口腔鳞癌OS及DFS的危险因素,并以此建立列线图模型。采用一致性指数(C指数)、受试者工作特征曲线(ROC)及校准曲线对列线图模型进行验证和评价。结果:共随访到277例患者结局,随访率76.73%。COX单因素及多因素分析结果显示,年龄、神经周围浸润、肿瘤分化程度及N分期均为OSCC患者OS的独立危险因素,年龄、神经周围浸润、肿瘤分化程度及临床分期均为OSCC患者DFS的独立危险因素(P<0.05)。基于多因素分析结果建立的列线图模型预测OSCC患者术后OS和DFS的C指数分别为0.741和0.763,受试者工作特征曲线及校准曲线均表明预后模型与实际观测结果拟合性较好。结论:基于年龄、神经周围浸润、肿瘤分化程度、N分期和临床分期构建的OSCC术后OS、DFS列线图模型具有良好的预测能力及精准度,有助于临床医师准确评估患者预后,指导临床个体化治疗。

Objective:To investigate the prognostic factors of patients with oral squamous cell carcinoma(OSCC)and to establish a nomogram predictive model for the prediction of overall survival(OS)and disease-free survival(DFS)of the patients with OSCC.Methods:A retrospective analysis was performed on clinicopathological data of 361 OSCC patients underwent surgical treatment.Log-rank test and Cox regression model were used to analyze the prognosis of patients with OSCC.The nomogram was established based on the results of multivariate analysis and the consistency index(C index).Receiver operating characteristic curve(ROC)and calibration curve were used to evaluate the prediction ability and accuracy of the nomogram.Results:277 patients(76.73%)were followed up in this study.Univariate and multivariate analysis showed that age,perineural invasion,tumor differentiation and N stage were the independent risk factors for OS of patients,while age,perineural invasion,tumor differentiation and clinical stage were the independent risk factors for DFS of the patients(all P<0.05).The C index of the nomogram for OS and DFS of OSCC patients established by this method was 0.741 and 0.763,respectively.ROC and calibration curves showed that the OS and DFS models fitted well with the actual observation results.Conclusion:The OS and DFS nomogram prognostic model of OSCC patients constructed based on age,perineural invasion,tumor differentiation,N stage and clinical stage has good predictive ability and accuracy,may help clinicians to accurately assess the prognosis of the patients,and have important significance for the individualized treatment of OSCC patients.