目的:基于监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)数据库,分析影响胰腺癌预后的独立因素并构建预测模型。方法:本研究从SEER数据库获取2010-2015年美国7801例胰腺癌病人的临床资料,以7∶3的比例随...目的:基于监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)数据库,分析影响胰腺癌预后的独立因素并构建预测模型。方法:本研究从SEER数据库获取2010-2015年美国7801例胰腺癌病人的临床资料,以7∶3的比例随机分为建模组、验证组。对建模组临床变量进行多因素COX回归分析获得影响生存的独立因素,构建列线图。通过受试者操作特性(receiver operating characteristic,ROC)曲线和校准曲线验证模型的准确性。结果:年龄、原发部位、病理分级、T分期、N分期、M分期、手术方式、放疗、化疗与胰腺癌的预后相关,总生存的3年、5年ROC曲线下面积(area under cure,AUC)分别为0.90、0.91,癌症特异性生存分别为0.91、0.91。校准曲线显示观察值与预测值之间具有良好的一致性。经筛选得到的临床变量确实对胰腺癌预后有影响。结论:所构建的模型具有较好的预测准确性,有助于胰腺癌病人的临床决策和个性化治疗。展开更多
目的:探讨原发性肝癌患者预后的危险因素,为该病患者的临床诊疗和预后判断提供科学依据。方法:以2018年监测、流行病学和结果(Surveillance,Epidemiology,and End Results,SEER)数据库原发性肝癌患者作为研究对象,收集人口学资料、临床...目的:探讨原发性肝癌患者预后的危险因素,为该病患者的临床诊疗和预后判断提供科学依据。方法:以2018年监测、流行病学和结果(Surveillance,Epidemiology,and End Results,SEER)数据库原发性肝癌患者作为研究对象,收集人口学资料、临床指标和预后随访信息,运用单因素和多因素logistic回归分析影响患者术后生存的危险因素。采用一致性指数评价模型的预测能力,构建受试者工作特征曲线分析预测模型的效能。采用绘制森林图的方法对不同分期下肝癌患者的治疗方式进行分析。结果:该研究共收集2018年原发性肝癌患者1750例。单因素logistic回归结果表明,肿瘤分期、淋巴结转移、远处转移、婚姻状况、放化疗及手术是影响原发性肝癌患者生存的危险因素(P<0.05);多因素logistic回归分析结果表明,肿瘤分期[T2/T3相对于T1,OR=5.142/3.390,95%CI=(3.654~7.236)(/2.327~4.939),P<0.001]、远处转移(OR=4.810,95%CI=3.384~6.839,P<0.001)、婚姻状况(OR=0.729,95%CI=0.575~0.925,P=0.009)、放疗(OR=0.361,95%CI=0.260~0.503,P<0.001)、化疗(OR=0.512,95%CI=0.381~0.687,P=0.001)以及手术(OR=0.245,95%CI=0.105~0.574,P=0.028)是影响肝癌患者生存的危险因素。将logistic回归中有意义的变量如肿瘤分期、远处转移、婚姻状况、放化疗和手术情况进行预测模型的构建,研究显示该模型一致性指数为0.786(95%CI=0.762~0.810),曲线下面积(area under the curve,AUC)为0.790(95%CI=0.764~0.812)。仅放疗这种干预方式在任何肿瘤分期的患者中都展现出了优势(P=0.003、P=0.013、P=0.003)。在未发生淋巴结转移的患者中无论哪种干预方式都会降低肝癌患者的病死率(P<0.001,P=0.001,P<0.001,P=0.004),但是在发生淋巴结转移的患者中,是否进行干预对肝癌患者的生存没有影响(P>0.05)。在未发生远处转移的患者中,仅进行放疗、化疗或化疗+放疗干预方式的患者与未进行干预的患者相比生存率更高(P<0.001,P=0.001,P<0.001,P=0.004),在发生远处转移的患者中,仅进行放疗的干预方式展现出优势(P=0.002)。结论:肿瘤分期、远处转移、婚姻状况、放化疗和手术情况是影响原发性肝癌预后的危险因素。展开更多
AIM To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreaticc arcinoma registered within the Surveillance, Epidemiology and End Results(SEER) database.METHODS SEER databas...AIM To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreaticc arcinoma registered within the Surveillance, Epidemiology and End Results(SEER) database.METHODS SEER database(2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases(liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailed P value < 0.05 was achieved. RESULTS A total of 13233 patients with stage Ⅳ pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases(for overall survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001)(for pancreatic cancer-specific survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival.CONCLUSION Pancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.展开更多
BACKGROUND In colorectal cancer, tumor deposits(TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases(LNMs). However, this definit...BACKGROUND In colorectal cancer, tumor deposits(TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases(LNMs). However, this definition and the subsequent prognostic value based on it is controversial, with various hypotheses. TDs may play an independent role when it comes to survival and addition of TDs to LNM count may predict the prognosis of patients more accurately.AIM To assess the prognostic impact of TDs and evaluate the effect of their addition to the LNM count.METHODS The patients are derived from the Surveillance, Epidemiology, and End Results database. A prognostic analysis regarding impact of TDs on overall survival(OS) was performed using Cox regression model, and other covariates associating with OS were adjusted. The effect of addition of TDs to LNM count on N restaging was also evaluated. The subgroup analysis was performed to explore the different profile of risk factors between patients with and without TDs.RESULTS Overall, 103755 patients were enrolled with 14131(13.6%) TD-positive and 89624(86.4%) TD-negative tumors. TD-positive patients had worse prognosis compared with TD-negative patients, with 3-year OS rates of 47.3%(95%CI, 46.5%-48.1%) and 77.5%(95%CI, 77.2%-77.8%, P < 0.0001), respectively. On multivariable analysis, TDs were associated poorer OS(hazard ratio, 1.35;95%CI, 1.31-1.38;P < 0.0001). Among TD-positive patients, the number of TDs had a linear negative effect on disease-free survival and OS. After reclassifying patients by adding TDs to the LNM count, 885 of 19 965(4.4%) N1 patients were restaged as p N2, with worse outcomes than patients restaged as p N1(3-year OS rate: 78.5%, 95%CI, 77.9%-79.1% vs 63.2%, 95%CI, 60.1%-66.5%, respectively;P < 0.0001).CONCLUSION TDs are an independent prognostic factor for OS in colorectal cancer. The addition of TDs to LNM count improved the prognostic accuracy of tumor, node and metastasis staging.展开更多
背景与目的原发性纵隔生殖细胞瘤(primary mediastinal germ cell tumor,PMGCT)是一种相对罕见且偶尔会具有高度侵袭性的纵隔肿瘤。目前对PMGCT的疾病特异性生存期(disease special survival,DSS)的相关研究报道较少,大数据分析亦相对较...背景与目的原发性纵隔生殖细胞瘤(primary mediastinal germ cell tumor,PMGCT)是一种相对罕见且偶尔会具有高度侵袭性的纵隔肿瘤。目前对PMGCT的疾病特异性生存期(disease special survival,DSS)的相关研究报道较少,大数据分析亦相对较少,DSS预后模型也较为少见。本研究旨在探讨影响PMGCT DSS的预后相关因素,并构建简便、有效、可对PMGCT患者DSS预后情况进行预测的列线图。方法回顾性分析从监测、流行病学和最终结果(Surveillance,Epidemiology,and End Results,SEER)数据库提取的1975年-2019年共347例PMGCT患者的临床病理资料。采用Kaplan-Meier法及Log-rank检验估计DSS。执行Cox比例风险回归模型筛选影响预后的独立危险因素,构建个体化列线图预测PMGCT患者的3年、5年、8年DSS。通过受试者工作特征(receiver operating characteristic,ROC)曲线、校正曲线及决策曲线分析(decision curve analysis,DCA)评估模型的预测精度。结果PMGCT患者的3年、5年、8年生存率分别为84.6%、83.6%、83.3%。单因素Cox回归分析显示组织学分型、手术与否、年龄、肿瘤大小、肿瘤转移情况及肿瘤分期6项因素可影响PMGCT的预后(P<0.05),多因素Cox回归分析显示组织学分型、手术与否、年龄、肿瘤大小是PMGCT患者预后的独立危险因素(P<0.05),利用这些独立危险因素构建了列线图模型。ROC的曲线下面积(area under the curve,AUC)为0.824,3年、5年、8年生存时间的校正曲线以及DCA曲线,三者结果提示本研究的列线图评估预测结果与真实结果之间有良好的一致性。结论PMGCT中组织学分型为精原细胞瘤的患者比非精原细胞瘤患者预后更佳,年龄>40岁、肿瘤大小≥15 cm且未进行过手术治疗的患者预后不佳。列线图模型可以对PMGCT患者的DSS进行准确直观的预测。展开更多
BACKGROUND Gastric cancer(GC)is prevalent and aggressive,especially when patients have distant lung metastases,which often places patients into advanced stages.By identifying prognostic variables for lung metastasis i...BACKGROUND Gastric cancer(GC)is prevalent and aggressive,especially when patients have distant lung metastases,which often places patients into advanced stages.By identifying prognostic variables for lung metastasis in GC patients,it may be po-ssible to construct a good prediction model for both overall survival(OS)and the cumulative incidence prediction(CIP)plot of the tumour.AIM To investigate the predictors of GC with lung metastasis(GCLM)to produce nomograms for OS and generate CIP by using cancer-specific survival(CSS)data.METHODS Data from January 2000 to December 2020 involving 1652 patients with GCLM were obtained from the Surveillance,epidemiology,and end results program database.The major observational endpoint was OS;hence,patients were se-parated into training and validation groups.Correlation analysis determined va-rious connections.Univariate and multivariate Cox analyses validated the independent predictive factors.Nomogram distinction and calibration were performed with the time-dependent area under the curve(AUC)and calibration curves.To evaluate the accuracy and clinical usefulness of the nomograms,decision curve analysis(DCA)was performed.The clinical utility of the novel prognostic model was compared to that of the 7th edition of the American Joint Committee on Cancer(AJCC)staging system by utilizing Net Reclassification Improvement(NRI)and Integrated Discrimination Improvement(IDI).Finally,the OS prognostic model and Cox-AJCC risk stratification model modified for the AJCC system were compared.RESULTS For the purpose of creating the OS nomogram,a CIP plot based on CSS was generated.Cox multivariate regression analysis identified eleven significant prognostic factors(P<0.05)related to liver metastasis,bone metastasis,primary site,surgery,regional surgery,treatment sequence,chemotherapy,radiotherapy,positive lymph node count,N staging,and time from diagnosis to treatment.It was clear from the DCA(net benefit>0),time-de-pendent ROC curve(training/validation set AUC>0.7),and calibration curve(reliability slope closer to 45 degrees)results that the OS nomogram demonstrated a high level of predictive efficiency.The OS prediction model(New Model AUC=0.83)also performed much better than the old Cox-AJCC model(AUC difference between the new model and the old model greater than 0)in terms of risk stratification(P<0.0001)and verification using the IDI and NRI.CONCLUSION The OS nomogram for GCLM successfully predicts 1-and 3-year OS.Moreover,this approach can help to ap-propriately classify patients into high-risk and low-risk groups,thereby guiding treatment.展开更多
目的构建远处转移性乳腺癌的有效预后列线图。方法从SEER(The Surveillance,Epidemiology,and End Results)数据库中筛选到2010年1月至2012年12月诊断为远处转移性乳腺癌的3989例病人,采用整群随机抽样法分为建模组(n=2993)和验证组(n=9...目的构建远处转移性乳腺癌的有效预后列线图。方法从SEER(The Surveillance,Epidemiology,and End Results)数据库中筛选到2010年1月至2012年12月诊断为远处转移性乳腺癌的3989例病人,采用整群随机抽样法分为建模组(n=2993)和验证组(n=996),使用Cox比例风险回归模型分析建模组预后独立危险因素,并构建预后列线图,利用内部自助重取样和验证组病人验证结果,列线图的预测准确性和判别能力由C指数和校准曲线确定。结果在对建模组病人的多因素分析中,生存的独立危险因素如年龄、婚姻状态、种族、组织学分级、雌激素受体(ER)状态、孕激素受体(PR)状态、人表皮生长因子受体2(Her-2)状态、T分期、原发灶手术、骨转移、脑转移、肝转移和肺转移都被选入列线图。生存概率的校准曲线显示出列线图预测良好的一致性,列线图预测生存的C指数为0.702[95%CI:(0.696,0.708)],在验证队列中,列线图的C指数为0.707[95%CI:(0.706,0.708)]。结论该列线图可以为远处转移性乳腺癌病人提供较为准确的预后预测。展开更多
目的探讨肝外胆管癌(extra-hepatic cholangiocarcinoma,ECC)的预后影响因素,并建立有效的列线图生存预测模型。方法收集SEER(Surveillance,Epidemiology,and End Results)数据库中2004—2015年诊断为ECC的患者临床资料,进行回顾性分析...目的探讨肝外胆管癌(extra-hepatic cholangiocarcinoma,ECC)的预后影响因素,并建立有效的列线图生存预测模型。方法收集SEER(Surveillance,Epidemiology,and End Results)数据库中2004—2015年诊断为ECC的患者临床资料,进行回顾性分析,采用SPSS软件对可能与预后相关的变量进行Cox回归分析,筛选出独立预后因素。使用R语言绘制ECC预后预测列线图模型,并采用C-index和校准曲线验证其准确性。结果共纳入3102例ECC患者。Cox分析显示,年龄、T分期、淋巴结转移、远处转移、肿瘤大小、手术治疗、化疗以及婚姻状态是ECC患者的独立预后因素。列线图模型校准曲线与理想曲线一致性较高,C-index为0.713,1、3、5年患者生存时间ROC曲线下面积分别为0.752、0.784、0.778。结论年龄、T分期、淋巴结转移、远处转移、肿瘤大小、手术治疗、化疗以及婚姻状态是ECC患者的独立预后因素,以此建立的列线图模型对ECC患者预后有一定的预测价值。展开更多
文摘目的:基于监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)数据库,分析影响胰腺癌预后的独立因素并构建预测模型。方法:本研究从SEER数据库获取2010-2015年美国7801例胰腺癌病人的临床资料,以7∶3的比例随机分为建模组、验证组。对建模组临床变量进行多因素COX回归分析获得影响生存的独立因素,构建列线图。通过受试者操作特性(receiver operating characteristic,ROC)曲线和校准曲线验证模型的准确性。结果:年龄、原发部位、病理分级、T分期、N分期、M分期、手术方式、放疗、化疗与胰腺癌的预后相关,总生存的3年、5年ROC曲线下面积(area under cure,AUC)分别为0.90、0.91,癌症特异性生存分别为0.91、0.91。校准曲线显示观察值与预测值之间具有良好的一致性。经筛选得到的临床变量确实对胰腺癌预后有影响。结论:所构建的模型具有较好的预测准确性,有助于胰腺癌病人的临床决策和个性化治疗。
文摘目的:探讨原发性肝癌患者预后的危险因素,为该病患者的临床诊疗和预后判断提供科学依据。方法:以2018年监测、流行病学和结果(Surveillance,Epidemiology,and End Results,SEER)数据库原发性肝癌患者作为研究对象,收集人口学资料、临床指标和预后随访信息,运用单因素和多因素logistic回归分析影响患者术后生存的危险因素。采用一致性指数评价模型的预测能力,构建受试者工作特征曲线分析预测模型的效能。采用绘制森林图的方法对不同分期下肝癌患者的治疗方式进行分析。结果:该研究共收集2018年原发性肝癌患者1750例。单因素logistic回归结果表明,肿瘤分期、淋巴结转移、远处转移、婚姻状况、放化疗及手术是影响原发性肝癌患者生存的危险因素(P<0.05);多因素logistic回归分析结果表明,肿瘤分期[T2/T3相对于T1,OR=5.142/3.390,95%CI=(3.654~7.236)(/2.327~4.939),P<0.001]、远处转移(OR=4.810,95%CI=3.384~6.839,P<0.001)、婚姻状况(OR=0.729,95%CI=0.575~0.925,P=0.009)、放疗(OR=0.361,95%CI=0.260~0.503,P<0.001)、化疗(OR=0.512,95%CI=0.381~0.687,P=0.001)以及手术(OR=0.245,95%CI=0.105~0.574,P=0.028)是影响肝癌患者生存的危险因素。将logistic回归中有意义的变量如肿瘤分期、远处转移、婚姻状况、放化疗和手术情况进行预测模型的构建,研究显示该模型一致性指数为0.786(95%CI=0.762~0.810),曲线下面积(area under the curve,AUC)为0.790(95%CI=0.764~0.812)。仅放疗这种干预方式在任何肿瘤分期的患者中都展现出了优势(P=0.003、P=0.013、P=0.003)。在未发生淋巴结转移的患者中无论哪种干预方式都会降低肝癌患者的病死率(P<0.001,P=0.001,P<0.001,P=0.004),但是在发生淋巴结转移的患者中,是否进行干预对肝癌患者的生存没有影响(P>0.05)。在未发生远处转移的患者中,仅进行放疗、化疗或化疗+放疗干预方式的患者与未进行干预的患者相比生存率更高(P<0.001,P=0.001,P<0.001,P=0.004),在发生远处转移的患者中,仅进行放疗的干预方式展现出优势(P=0.002)。结论:肿瘤分期、远处转移、婚姻状况、放化疗和手术情况是影响原发性肝癌预后的危险因素。
文摘AIM To evaluate the prognostic value of site-specific metastases among patients with metastatic pancreaticc arcinoma registered within the Surveillance, Epidemiology and End Results(SEER) database.METHODS SEER database(2010-2013) has been queried through SEER*Stat program to determine the presentation, treatment outcomes and prognostic outcomes of metastatic pancreatic adenocarcinoma according to the site of metastasis. In this study, metastatic pancreatic adenocarcinoma patients were classified according to the site of metastases(liver, lung, bone, brain and distant lymph nodes). We utilized chi-square test to compare the clinicopathological characteristics among different sites of metastases. We used Kaplan-Meier analysis and log-rank testing for survival comparisons. We employed Cox proportional model to perform multivariate analyses of the patient population; and accordingly hazard ratios with corresponding 95%CI were generated. Statistical significance was considered if a two-tailed P value < 0.05 was achieved. RESULTS A total of 13233 patients with stage Ⅳ pancreatic cancer and known sites of distant metastases were identified in the period from 2010-2013 and they were included into the current analysis. Patients with isolated distant nodal involvement or lung metastases have better overall and pancreatic cancer-specific survival compared to patients with isolated liver metastases(for overall survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001)(for pancreatic cancer-specific survival: lung vs liver metastases: P < 0.0001; distant nodal vs liver metastases: P < 0.0001). Multivariate analysis revealed that age < 65 years, white race, being married, female gender; surgery to the primary tumor and surgery to the metastatic disease were associated with better overall survival and pancreatic cancer-specific survival.CONCLUSION Pancreatic adenocarcinoma patients with isolated liver metastases have worse outcomes compared to patients with isolated lung or distant nodal metastases. Further research is needed to identify the highly selected subset of patients who may benefit from local treatment of the primary tumor and/or metastatic disease.
基金Supported by the Scientific and Technological Project of Qinghai Province,China,No. 2015-ZJ-742。
文摘BACKGROUND In colorectal cancer, tumor deposits(TDs) are considered to be a prognostic factor in the current staging system, and are only considered in the absence of lymph node metastases(LNMs). However, this definition and the subsequent prognostic value based on it is controversial, with various hypotheses. TDs may play an independent role when it comes to survival and addition of TDs to LNM count may predict the prognosis of patients more accurately.AIM To assess the prognostic impact of TDs and evaluate the effect of their addition to the LNM count.METHODS The patients are derived from the Surveillance, Epidemiology, and End Results database. A prognostic analysis regarding impact of TDs on overall survival(OS) was performed using Cox regression model, and other covariates associating with OS were adjusted. The effect of addition of TDs to LNM count on N restaging was also evaluated. The subgroup analysis was performed to explore the different profile of risk factors between patients with and without TDs.RESULTS Overall, 103755 patients were enrolled with 14131(13.6%) TD-positive and 89624(86.4%) TD-negative tumors. TD-positive patients had worse prognosis compared with TD-negative patients, with 3-year OS rates of 47.3%(95%CI, 46.5%-48.1%) and 77.5%(95%CI, 77.2%-77.8%, P < 0.0001), respectively. On multivariable analysis, TDs were associated poorer OS(hazard ratio, 1.35;95%CI, 1.31-1.38;P < 0.0001). Among TD-positive patients, the number of TDs had a linear negative effect on disease-free survival and OS. After reclassifying patients by adding TDs to the LNM count, 885 of 19 965(4.4%) N1 patients were restaged as p N2, with worse outcomes than patients restaged as p N1(3-year OS rate: 78.5%, 95%CI, 77.9%-79.1% vs 63.2%, 95%CI, 60.1%-66.5%, respectively;P < 0.0001).CONCLUSION TDs are an independent prognostic factor for OS in colorectal cancer. The addition of TDs to LNM count improved the prognostic accuracy of tumor, node and metastasis staging.
文摘背景与目的原发性纵隔生殖细胞瘤(primary mediastinal germ cell tumor,PMGCT)是一种相对罕见且偶尔会具有高度侵袭性的纵隔肿瘤。目前对PMGCT的疾病特异性生存期(disease special survival,DSS)的相关研究报道较少,大数据分析亦相对较少,DSS预后模型也较为少见。本研究旨在探讨影响PMGCT DSS的预后相关因素,并构建简便、有效、可对PMGCT患者DSS预后情况进行预测的列线图。方法回顾性分析从监测、流行病学和最终结果(Surveillance,Epidemiology,and End Results,SEER)数据库提取的1975年-2019年共347例PMGCT患者的临床病理资料。采用Kaplan-Meier法及Log-rank检验估计DSS。执行Cox比例风险回归模型筛选影响预后的独立危险因素,构建个体化列线图预测PMGCT患者的3年、5年、8年DSS。通过受试者工作特征(receiver operating characteristic,ROC)曲线、校正曲线及决策曲线分析(decision curve analysis,DCA)评估模型的预测精度。结果PMGCT患者的3年、5年、8年生存率分别为84.6%、83.6%、83.3%。单因素Cox回归分析显示组织学分型、手术与否、年龄、肿瘤大小、肿瘤转移情况及肿瘤分期6项因素可影响PMGCT的预后(P<0.05),多因素Cox回归分析显示组织学分型、手术与否、年龄、肿瘤大小是PMGCT患者预后的独立危险因素(P<0.05),利用这些独立危险因素构建了列线图模型。ROC的曲线下面积(area under the curve,AUC)为0.824,3年、5年、8年生存时间的校正曲线以及DCA曲线,三者结果提示本研究的列线图评估预测结果与真实结果之间有良好的一致性。结论PMGCT中组织学分型为精原细胞瘤的患者比非精原细胞瘤患者预后更佳,年龄>40岁、肿瘤大小≥15 cm且未进行过手术治疗的患者预后不佳。列线图模型可以对PMGCT患者的DSS进行准确直观的预测。
基金Supported by Peng-Cheng Talent-Medical Young Reserve Talent Training Program,No.XWRCHT20220002Xuzhou City Health and Health Commission Technology Project Contract,No.XWKYHT20230081and Key Research and Development Plan Project of Xuzhou City,No.KC22179.
文摘BACKGROUND Gastric cancer(GC)is prevalent and aggressive,especially when patients have distant lung metastases,which often places patients into advanced stages.By identifying prognostic variables for lung metastasis in GC patients,it may be po-ssible to construct a good prediction model for both overall survival(OS)and the cumulative incidence prediction(CIP)plot of the tumour.AIM To investigate the predictors of GC with lung metastasis(GCLM)to produce nomograms for OS and generate CIP by using cancer-specific survival(CSS)data.METHODS Data from January 2000 to December 2020 involving 1652 patients with GCLM were obtained from the Surveillance,epidemiology,and end results program database.The major observational endpoint was OS;hence,patients were se-parated into training and validation groups.Correlation analysis determined va-rious connections.Univariate and multivariate Cox analyses validated the independent predictive factors.Nomogram distinction and calibration were performed with the time-dependent area under the curve(AUC)and calibration curves.To evaluate the accuracy and clinical usefulness of the nomograms,decision curve analysis(DCA)was performed.The clinical utility of the novel prognostic model was compared to that of the 7th edition of the American Joint Committee on Cancer(AJCC)staging system by utilizing Net Reclassification Improvement(NRI)and Integrated Discrimination Improvement(IDI).Finally,the OS prognostic model and Cox-AJCC risk stratification model modified for the AJCC system were compared.RESULTS For the purpose of creating the OS nomogram,a CIP plot based on CSS was generated.Cox multivariate regression analysis identified eleven significant prognostic factors(P<0.05)related to liver metastasis,bone metastasis,primary site,surgery,regional surgery,treatment sequence,chemotherapy,radiotherapy,positive lymph node count,N staging,and time from diagnosis to treatment.It was clear from the DCA(net benefit>0),time-de-pendent ROC curve(training/validation set AUC>0.7),and calibration curve(reliability slope closer to 45 degrees)results that the OS nomogram demonstrated a high level of predictive efficiency.The OS prediction model(New Model AUC=0.83)also performed much better than the old Cox-AJCC model(AUC difference between the new model and the old model greater than 0)in terms of risk stratification(P<0.0001)and verification using the IDI and NRI.CONCLUSION The OS nomogram for GCLM successfully predicts 1-and 3-year OS.Moreover,this approach can help to ap-propriately classify patients into high-risk and low-risk groups,thereby guiding treatment.
文摘目的构建远处转移性乳腺癌的有效预后列线图。方法从SEER(The Surveillance,Epidemiology,and End Results)数据库中筛选到2010年1月至2012年12月诊断为远处转移性乳腺癌的3989例病人,采用整群随机抽样法分为建模组(n=2993)和验证组(n=996),使用Cox比例风险回归模型分析建模组预后独立危险因素,并构建预后列线图,利用内部自助重取样和验证组病人验证结果,列线图的预测准确性和判别能力由C指数和校准曲线确定。结果在对建模组病人的多因素分析中,生存的独立危险因素如年龄、婚姻状态、种族、组织学分级、雌激素受体(ER)状态、孕激素受体(PR)状态、人表皮生长因子受体2(Her-2)状态、T分期、原发灶手术、骨转移、脑转移、肝转移和肺转移都被选入列线图。生存概率的校准曲线显示出列线图预测良好的一致性,列线图预测生存的C指数为0.702[95%CI:(0.696,0.708)],在验证队列中,列线图的C指数为0.707[95%CI:(0.706,0.708)]。结论该列线图可以为远处转移性乳腺癌病人提供较为准确的预后预测。
文摘目的探讨肝外胆管癌(extra-hepatic cholangiocarcinoma,ECC)的预后影响因素,并建立有效的列线图生存预测模型。方法收集SEER(Surveillance,Epidemiology,and End Results)数据库中2004—2015年诊断为ECC的患者临床资料,进行回顾性分析,采用SPSS软件对可能与预后相关的变量进行Cox回归分析,筛选出独立预后因素。使用R语言绘制ECC预后预测列线图模型,并采用C-index和校准曲线验证其准确性。结果共纳入3102例ECC患者。Cox分析显示,年龄、T分期、淋巴结转移、远处转移、肿瘤大小、手术治疗、化疗以及婚姻状态是ECC患者的独立预后因素。列线图模型校准曲线与理想曲线一致性较高,C-index为0.713,1、3、5年患者生存时间ROC曲线下面积分别为0.752、0.784、0.778。结论年龄、T分期、淋巴结转移、远处转移、肿瘤大小、手术治疗、化疗以及婚姻状态是ECC患者的独立预后因素,以此建立的列线图模型对ECC患者预后有一定的预测价值。
