摘要
目的普通型软骨肉瘤是最常见的软骨肉瘤,预后较差,需要个体化生存预测模型准确地指导患者管理。本研究构建普通型软骨肉瘤患者总生存期(overall survival,OS)预测列线图以指导患者的管理。方法从SEER数据库中选取普通型软骨肉瘤患者955例,随机分为训练队列668例和验证队列287例。训练队列中采用单因素Cox分析和多因素Cox比例风险回归分析确定预后危险因素,根据多因素Cox比例风险回归的结果构建列线图模型。训练队列内验证和验证队列外验证中通过一致性指数(concordance indexe,C-index)和校准曲线评价该模型的准确性和一致性。基于患者个体化列线图的总得分,构建普通型软骨肉瘤患者的风险分层。结果所有患者中诊断年龄(P<0.001)、分期(P<0.001)、分化程度(P<0.001)、手术(P<0.001)、婚姻状态(P=0.008)以及肿瘤直径(P=0.027)均是骨普通型软骨肉瘤的预后危险因素。预测列线图的训练队列内验证C-index=0.82(95%CI为0.78~0.86),验证队列外验证C-index=0.84(95%CI为0.79~0.89),校准曲线显示列线图预测的生存率与实际生存率接近。基于列线图的总得分,将风险分层分为低风险组、中风险组和高风险组,组间比较差异均有统计学意义,P<0.001;训练队列和验证队列中风险分层差异均有统计学意义,均P<0.001。结论普通型软骨肉瘤患者OS的预测列线图,能相对准确预测普通型软骨肉瘤患者1年、3年和5年的OS,为临床医生更加准确地预测患者的OS以及实现患者的风险分层管理提供科学依据。
OBJECTIVE Patients with chondrosarcoma not otherwise specified(chondro-sarcoma NOS)are the most common chondrosarcoma with poor prognosis and lack individualized prognosis models.In order to predict the prognosis accurately and to guide the management of patients,we develop credible nomograms to predict overall survival(OS)for patients with chondrosarcoma not otherwise specified.METHODS Totally 955chondrosarcoma NOS participants were identified in the Surveillance,Epidemiology,and End Result(SEER)database,and were randomly assigned into the training cohort(n=668)and the validation cohort(n=287).The prognostic factors for PMCTs were identified by univariate and multivariate Cox analysis,and further incorporated to build OS nomograms in the training cohort.The nomograms were internally and externally validated via concordance indexes(C-index)and calibration curves.According to the total score of nomogram,we developed a risk classification system.RESULTS The independent prognostic factors for OS in chondrosarcoma NOS were associated with age at diagnosis(P<0.001),tumor stage(P<0.001),grade(P<0.001),cancer-directed surgery(P<0.001),marital status(P=0.008)and tumor size(P=0.027).In the internal validation,the C-index values were 0.82(95%CI:0.78-0.86)for OS nomogram.In the external validation,the C-index values were 0.84(95%CI:0.79-0.89)for OS nomogram.The calibration curves of internal and external validation showed consistency between the nomograms and the actual observation.We divided the chondrosarcoma OS participants into three risk groups:low-risk group,intermediate-risk group and high-risk group(all P<0.001).CONCLUSION We identified and developed credible nomograms to predict 1-year,3-year and 5-year OS in chondrosarcoma NOS,which is very significant for more precisely estimate the survival.
作者
于蒙洋
王斌
黄帅
钟少文
陈灿伟
刘圣曜
YU Meng-yang;WANG Bin;HUANG Shuai;ZHONG Shao-wen;CHEN Can-wei;LIU Sheng-yao(Department of Orthopedic,Second Hospital Affiliated to Guangzhou Medical University,Guangzhou510260,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2020年第16期1327-1334,共8页
Chinese Journal of Cancer Prevention and Treatment
基金
广东省自然科学基金(2020A1515010211)。
关键词
普通型软骨肉瘤
总生存期
列线图
风险分层
SEER数据库
chondrosarcoma not otherwise specified
overall survival
nomogram
risk classification system
SEER database
