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 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
BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare distinct subtype of precursor lesions of biliary carcinoma.IPNB is considered to originate from luminal biliary epithelial cells,typically disp...BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare distinct subtype of precursor lesions of biliary carcinoma.IPNB is considered to originate from luminal biliary epithelial cells,typically displays mucin-hypersecretion or a papillary growth pattern,and results in cystic dilatation[1].IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts,and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma.IPNBs have similar phenotypic changes in the occurrence and development of all subtypes,and the prognosis is significantly better than that of traditional(nonpapillary)cholangiocarcinoma.AIM To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.METHODS Invasive IPNB,invasive intraductal papillary mucinous neoplasm of the pancreas(IPMN),and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.Annual percentage changes(APCs)in the incidence and incidence-based(IB)mortality were calculated.We identified the independent predictors of overall survival(OS)and cancer-specific survival(CSS)in indivi duals with invasive IPNB.RESULTS The incidence and IB mortality of invasive IPNB showed sustained decreases,with an APC of-4.5%(95%CI:-5.1%to-3.8%)and-3.3%(95%CI:-4.1%to-2.6%)(P<0.001),respectively.Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma.Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma.A total of 1635 individuals with invasive IPNB were included in our prognosis analysis.The most common tumor sites were the pancreaticobiliary ampulla(47.9%)and perihilar tract(36.7%),but the mucin-related subtype of invasive IPNB was the main type,intrahepatically(approximately 90%).In the univariate and multivariate Cox regression analysis,age,tumor site,grade and stage,subtype,surgery,and chemotherapy were associated with OS and CSS(P<0.05).CONCLUSION Incidence and IB mortality of invasive IPNB trended steadily downward.The heterogeneity of IPNB comprises site and the tumor’s mucin-producing status.展开更多
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
Many high quality studies have emerged from public databases,such as Surveillance,Epidemiology,and End Results(SEER),National Health and Nutrition Examination Survey(NHANES),The Cancer Genome Atlas(TCGA),and Medical I...Many high quality studies have emerged from public databases,such as Surveillance,Epidemiology,and End Results(SEER),National Health and Nutrition Examination Survey(NHANES),The Cancer Genome Atlas(TCGA),and Medical Information Mart for Intensive Care(MIMIC);however,these data are often characterized by a high degree of dimensional heterogeneity,timeliness,scarcity,irregularity,and other characteristics,resulting in the value of these data not being fully utilized.Data-mining technology has been a frontier field in medical research,as it demonstrates excellent performance in evaluating patient risks and assisting clinical decision-making in building disease-prediction models.Therefore,data mining has unique advantages in clinical big-data research,especially in large-scale medical public databases.This article introduced the main medical public database and described the steps,tasks,and models of data mining in simple language.Additionally,we described data-mining methods along with their practical applications.The goal of this work was to aid clinical researchers in gaining a clear and intuitive understanding of the application of data-mining technology on clinical big-data in order to promote the production of research results that are beneficial to doctors and patients.展开更多
BACKGROUND Mucinous adenocarcinoma(MC)has attracted much attention as a distinct histologic subtype of colorectal cancer in recent years.However,data about its epidemiologic and prognostic characteristics are limited....BACKGROUND Mucinous adenocarcinoma(MC)has attracted much attention as a distinct histologic subtype of colorectal cancer in recent years.However,data about its epidemiologic and prognostic characteristics are limited.Therefore,patient data extracted from the National Cancer Institute’s Surveillance,Epidemiology,and End Results Program were collected to analyze the epidemiologic and clinicopathological characteristics of MC.AIM To determine the epidemiologic and clinicopathological characteristics of MC.METHODS The incidence trend of MC was calculated through the Joinpoint Regression Program.Cox regression analyses were performed to identify prognostic factors associated with overall survival(OS).A nomogram was established to predict the survival probability of individual patients with MC.RESULTS We found that rates of MC decreased from 4.50/100000 in 2000 to 1.54/100000 in 2018.Rates of MCs in patients aged≤50 years decreased 2.27%/year during 2000-2018.The incidence of appendiceal MCs increased from 0.14/100000 in 2000 to 0.24/100000 in 2018,while the incidence in other anatomic subsites continued to decrease.On multivariable Cox analyses,age,race,tumor site,T stage,N stage,M stage,surgery,and chemotherapy were associated with OS.A nomogram was developed based on these factors,and the area under the curve for 1-year,3-year,and 5-year OS in the training cohort was 0.778,0.778,and 0.768,respectively.CONCLUSION Our results demonstrated that MC incidence decreased in almost all anatomic subgroups except for the appendix.A nomogram predicting the survival probability of patients with MCs showed good performance.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
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 Combined hepatocellular and cholangiocarcinoma(HCC/CC)is a rare primary hepatic malignancy which carries a poor prognosis due to its aggressive nature.Few centers have enough cases to draw definitive conclu...BACKGROUND Combined hepatocellular and cholangiocarcinoma(HCC/CC)is a rare primary hepatic malignancy which carries a poor prognosis due to its aggressive nature.Few centers have enough cases to draw definitive conclusions and there is limited understanding of prognosis.Given the rarity of HCC/CC,an analysis of large national cancer database was needed to obtain larger number of HCC/CC cases.AIM To identify associated factors for 5-year survival of HCC/CC.METHODS We conducted a retrospective study of The Surveillance,Epidemiology,and End Results(SEER)database obtained from SEER*Stat 8.3.6 software.Previously defined histology code 8180 for the International Classification of Disease for Oncology,3rd edition was used to identify HCC/CC cases from 2004 to 2015.We collected demographics,American Joint Committee on Cancer(AJCC)stage,treatment,tumor size,and survival data.These data were converted to categorical variables.The Shapiro-Wilk normality test was used to assess normal distribution.Mann-Whitney U test was used to compare continuous variables without normal distribution,and t-test was used to compare continuous variables with a normal distribution.The Kaplan-Meier survival curve analyzed 5-year survival.Univariate and multivariate logistic regression model was used to analyze factors associated with 5-year survival.Multivariate Cox proportional hazard regression was done on 5-year survival.We defined P<0.05 was statistically significant.RESULTS We identified 497 patients with the following characteristics:Mean age 62.4 years(SD:11.3),149(30.0%)were female,racial distribution was:276(55.5%)white,53(10.7%)black,84(16.9%)Asian and Pacific Islander(API),77(15.5%)Hispanic,and 7(1.4%)others or unknown.Stage I/II disease occurred in 41.5%and tumor size<50 mm was seen in 35.6%of patients.Twenty-four(4.8%)received locoregional therapy(LRT),119(23.9%)underwent resection,and 50(10.1%)underwent liver transplantation.The overall median survival was 6 mo[Interquartile range(IQR):1-22].After multivariate logistic regression,tumor size<50 mm[Odds ratios(OR):2.415,P=0.05],resection(OR:12.849,P<0.01),and transplant(OR:27.129,P<0.01)showed significance for 5-year survival.Age>60,sex,race,AJCC stages,metastasis,and LRT were not significant.However,API vs white showed significant OR of 2.793(CI:1.120-6.967).Cox proportional hazard regression showed AJCC stages,tumor size<50 mm,LRT,resection,and transplant showed significant hazard ratio.CONCLUSION HCC/CC patients with tumor size<50 mm,resection,and transplant were associated with an increase in 5-year survival.API showed advantageous OR and hazard ratios over white,black.展开更多
目的分析初诊Ⅳ期胃癌/食管胃结合部癌肝转移患者的临床病理特征,探索此类患者的预后因素。方法通过美国国立癌症研究所监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)*Stat软件收集SEER数据库中2010—2015...目的分析初诊Ⅳ期胃癌/食管胃结合部癌肝转移患者的临床病理特征,探索此类患者的预后因素。方法通过美国国立癌症研究所监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)*Stat软件收集SEER数据库中2010—2015年1614例Ⅳ期胃癌/食管胃结合部癌患者的临床资料。采用χ2检验比较肝转移(641例)和非肝转移(973例)患者临床病理特征的差异,采用二项分类Logistic回归分析探讨发生肝转移的影响因素;采用Kaplan-Meier法计算总生存(overall survival,OS),通过Log-Rank检验计算各因素OS的差异。通过多因素COX回归模型分析Ⅳ期胃癌/食管胃结合部癌肝转移患者预后的独立危险因素。结果肝转移和非肝转移患者临床病理特征中差异有统计学意义的因素包括:诊断年龄、种族、性别、原发灶部位、T分期、N分期、组织学分型、分化程度(均P<0.05)。二项分类Logistic回归分析结果提示,诊断年龄、种族、性别、原发灶部位、组织学分型、分化程度、骨转移、肺转移均为Ⅳ期胃癌/食管胃结合部癌患者发生肝转移的危险因素(均P<0.05)。641例胃癌/食管胃结合部癌肝转移患者的中位生存时间为3个月。单因素生存分析结果显示,诊断年龄、N分期、组织学分型、分化程度、原发灶手术、肺转移均与Ⅳ期胃癌/食管胃结合部癌肝转移患者生存情况有显著相关性(均P<0.05)。多因素COX回归模型分析显示,诊断年龄、N分期、组织学分型、分化程度、原发灶手术、肺转移均为Ⅳ期胃癌/食管胃结合部癌肝转移患者预后的独立影响因素(均P<0.05)。结论Ⅳ期胃癌/食管胃结合部癌具有独特的临床病理特征。发生肝转移的患者整体预后较差,诊断年龄、N分期、组织学分型、分化程度、原发灶手术和肺转移均为Ⅳ期胃癌/食管胃结合部癌肝转移患者预后的独立影响因素。展开更多
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 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.
基金Supported by the National Natural Science Foundation of China,No. 81860431 and 82060447the Jiangxi Natural Science Foundation,No. 20181BBG70025
文摘BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare distinct subtype of precursor lesions of biliary carcinoma.IPNB is considered to originate from luminal biliary epithelial cells,typically displays mucin-hypersecretion or a papillary growth pattern,and results in cystic dilatation[1].IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts,and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma.IPNBs have similar phenotypic changes in the occurrence and development of all subtypes,and the prognosis is significantly better than that of traditional(nonpapillary)cholangiocarcinoma.AIM To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.METHODS Invasive IPNB,invasive intraductal papillary mucinous neoplasm of the pancreas(IPMN),and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance,Epidemiology,and End Results(SEER)database.Annual percentage changes(APCs)in the incidence and incidence-based(IB)mortality were calculated.We identified the independent predictors of overall survival(OS)and cancer-specific survival(CSS)in indivi duals with invasive IPNB.RESULTS The incidence and IB mortality of invasive IPNB showed sustained decreases,with an APC of-4.5%(95%CI:-5.1%to-3.8%)and-3.3%(95%CI:-4.1%to-2.6%)(P<0.001),respectively.Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma.Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma.A total of 1635 individuals with invasive IPNB were included in our prognosis analysis.The most common tumor sites were the pancreaticobiliary ampulla(47.9%)and perihilar tract(36.7%),but the mucin-related subtype of invasive IPNB was the main type,intrahepatically(approximately 90%).In the univariate and multivariate Cox regression analysis,age,tumor site,grade and stage,subtype,surgery,and chemotherapy were associated with OS and CSS(P<0.05).CONCLUSION Incidence and IB mortality of invasive IPNB trended steadily downward.The heterogeneity of IPNB comprises site and the tumor’s mucin-producing status.
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。
基金the National Social Science Foundation of China(No.16BGL183).
文摘Many high quality studies have emerged from public databases,such as Surveillance,Epidemiology,and End Results(SEER),National Health and Nutrition Examination Survey(NHANES),The Cancer Genome Atlas(TCGA),and Medical Information Mart for Intensive Care(MIMIC);however,these data are often characterized by a high degree of dimensional heterogeneity,timeliness,scarcity,irregularity,and other characteristics,resulting in the value of these data not being fully utilized.Data-mining technology has been a frontier field in medical research,as it demonstrates excellent performance in evaluating patient risks and assisting clinical decision-making in building disease-prediction models.Therefore,data mining has unique advantages in clinical big-data research,especially in large-scale medical public databases.This article introduced the main medical public database and described the steps,tasks,and models of data mining in simple language.Additionally,we described data-mining methods along with their practical applications.The goal of this work was to aid clinical researchers in gaining a clear and intuitive understanding of the application of data-mining technology on clinical big-data in order to promote the production of research results that are beneficial to doctors and patients.
基金Supported by Science&Technology Department of Sichuan Province,No.2021JDTD0003Scientific Research Cooperation Project of Suining First People’s Hospital and the Affiliated Hospital of Southwest Medical University,No.2021SNXNYD05.
文摘BACKGROUND Mucinous adenocarcinoma(MC)has attracted much attention as a distinct histologic subtype of colorectal cancer in recent years.However,data about its epidemiologic and prognostic characteristics are limited.Therefore,patient data extracted from the National Cancer Institute’s Surveillance,Epidemiology,and End Results Program were collected to analyze the epidemiologic and clinicopathological characteristics of MC.AIM To determine the epidemiologic and clinicopathological characteristics of MC.METHODS The incidence trend of MC was calculated through the Joinpoint Regression Program.Cox regression analyses were performed to identify prognostic factors associated with overall survival(OS).A nomogram was established to predict the survival probability of individual patients with MC.RESULTS We found that rates of MC decreased from 4.50/100000 in 2000 to 1.54/100000 in 2018.Rates of MCs in patients aged≤50 years decreased 2.27%/year during 2000-2018.The incidence of appendiceal MCs increased from 0.14/100000 in 2000 to 0.24/100000 in 2018,while the incidence in other anatomic subsites continued to decrease.On multivariable Cox analyses,age,race,tumor site,T stage,N stage,M stage,surgery,and chemotherapy were associated with OS.A nomogram was developed based on these factors,and the area under the curve for 1-year,3-year,and 5-year OS in the training cohort was 0.778,0.778,and 0.768,respectively.CONCLUSION Our results demonstrated that MC incidence decreased in almost all anatomic subgroups except for the appendix.A nomogram predicting the survival probability of patients with MCs showed good performance.
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。
文摘BACKGROUND Combined hepatocellular and cholangiocarcinoma(HCC/CC)is a rare primary hepatic malignancy which carries a poor prognosis due to its aggressive nature.Few centers have enough cases to draw definitive conclusions and there is limited understanding of prognosis.Given the rarity of HCC/CC,an analysis of large national cancer database was needed to obtain larger number of HCC/CC cases.AIM To identify associated factors for 5-year survival of HCC/CC.METHODS We conducted a retrospective study of The Surveillance,Epidemiology,and End Results(SEER)database obtained from SEER*Stat 8.3.6 software.Previously defined histology code 8180 for the International Classification of Disease for Oncology,3rd edition was used to identify HCC/CC cases from 2004 to 2015.We collected demographics,American Joint Committee on Cancer(AJCC)stage,treatment,tumor size,and survival data.These data were converted to categorical variables.The Shapiro-Wilk normality test was used to assess normal distribution.Mann-Whitney U test was used to compare continuous variables without normal distribution,and t-test was used to compare continuous variables with a normal distribution.The Kaplan-Meier survival curve analyzed 5-year survival.Univariate and multivariate logistic regression model was used to analyze factors associated with 5-year survival.Multivariate Cox proportional hazard regression was done on 5-year survival.We defined P<0.05 was statistically significant.RESULTS We identified 497 patients with the following characteristics:Mean age 62.4 years(SD:11.3),149(30.0%)were female,racial distribution was:276(55.5%)white,53(10.7%)black,84(16.9%)Asian and Pacific Islander(API),77(15.5%)Hispanic,and 7(1.4%)others or unknown.Stage I/II disease occurred in 41.5%and tumor size<50 mm was seen in 35.6%of patients.Twenty-four(4.8%)received locoregional therapy(LRT),119(23.9%)underwent resection,and 50(10.1%)underwent liver transplantation.The overall median survival was 6 mo[Interquartile range(IQR):1-22].After multivariate logistic regression,tumor size<50 mm[Odds ratios(OR):2.415,P=0.05],resection(OR:12.849,P<0.01),and transplant(OR:27.129,P<0.01)showed significance for 5-year survival.Age>60,sex,race,AJCC stages,metastasis,and LRT were not significant.However,API vs white showed significant OR of 2.793(CI:1.120-6.967).Cox proportional hazard regression showed AJCC stages,tumor size<50 mm,LRT,resection,and transplant showed significant hazard ratio.CONCLUSION HCC/CC patients with tumor size<50 mm,resection,and transplant were associated with an increase in 5-year survival.API showed advantageous OR and hazard ratios over white,black.
文摘目的分析初诊Ⅳ期胃癌/食管胃结合部癌肝转移患者的临床病理特征,探索此类患者的预后因素。方法通过美国国立癌症研究所监测、流行病学和最终结果(surveillance,epidemiology,and end results,SEER)*Stat软件收集SEER数据库中2010—2015年1614例Ⅳ期胃癌/食管胃结合部癌患者的临床资料。采用χ2检验比较肝转移(641例)和非肝转移(973例)患者临床病理特征的差异,采用二项分类Logistic回归分析探讨发生肝转移的影响因素;采用Kaplan-Meier法计算总生存(overall survival,OS),通过Log-Rank检验计算各因素OS的差异。通过多因素COX回归模型分析Ⅳ期胃癌/食管胃结合部癌肝转移患者预后的独立危险因素。结果肝转移和非肝转移患者临床病理特征中差异有统计学意义的因素包括:诊断年龄、种族、性别、原发灶部位、T分期、N分期、组织学分型、分化程度(均P<0.05)。二项分类Logistic回归分析结果提示,诊断年龄、种族、性别、原发灶部位、组织学分型、分化程度、骨转移、肺转移均为Ⅳ期胃癌/食管胃结合部癌患者发生肝转移的危险因素(均P<0.05)。641例胃癌/食管胃结合部癌肝转移患者的中位生存时间为3个月。单因素生存分析结果显示,诊断年龄、N分期、组织学分型、分化程度、原发灶手术、肺转移均与Ⅳ期胃癌/食管胃结合部癌肝转移患者生存情况有显著相关性(均P<0.05)。多因素COX回归模型分析显示,诊断年龄、N分期、组织学分型、分化程度、原发灶手术、肺转移均为Ⅳ期胃癌/食管胃结合部癌肝转移患者预后的独立影响因素(均P<0.05)。结论Ⅳ期胃癌/食管胃结合部癌具有独特的临床病理特征。发生肝转移的患者整体预后较差,诊断年龄、N分期、组织学分型、分化程度、原发灶手术和肺转移均为Ⅳ期胃癌/食管胃结合部癌肝转移患者预后的独立影响因素。
