摘要
目的评估经手术治疗的Merkel细胞癌患者总体生存率的预后因素,并依此建立列线图用于预测患者3年及5年总体生存率。方法从美国国家癌症研究所的监测、流行病学、结果数据库(SEER)提取1271例符合条件的患者,按70∶30的比例分为建模组(891例)和验证组(380例)。使用R软件拟合Cox回归模型,确认预后因素并绘制3年及5年总体生存率列线图。模型的区分度用C指数(C-index)进行评价,模型的一致性用校准曲线进行评价。最后将模型的预测能力和第八版TNM分期系统进行对比。结果多因素Cox分析提示:年龄、性别、肿瘤大小、N分期、M分期、婚姻状态和放疗均和总生存率相关。我们将上述预测因素纳入预测模型,结果发现,新模型对于生存率的预测能力优于最新版的TNM分期:建模组使用新模型进行生存率预测的C指数为0.72,使用TNM分期的C指数为0.64;验证组使用新模型进行生存率预测的C指数为0.73,使用TNM分期的C指数为0.63。两组的校准曲线表现优异。结论包含综合评价指标的新模型对于Merkel细胞癌患者预后的预测效果优于传统的TNM分期。该新模型可协助医师更准确判断患者预后,协助临床决策和个体化治疗。
Objective To identify prognosis factors in patients with resected Merkel cell carcinoma and construct a nomogram for predicting 3-and 5-year overall survival.Methods A total of 1271 patients were extracted from the Surveillance,Epidemiology,and End Results(SEER)database.According to the ratio of 70:30,patients were randomly divided into training cohort(n=891)and validation cohort(n=380).Cox regression model was fitted with R software,thus the prognostic factors for 3-and 5-year overall survival were confirmed and a nomogram to predict overall survival was established.C-index was used to evaluate model discrimination and the calibration plot was used to evaluate model accuracy.The predictive power of the model was compared with the eighth TNM staging system.Results Multivariable cox analysis indicated age,sex,tumor size,N stage,M stage,marital status and radiation therapy were associated with overall survival.The above predictors were employed to build a new nomogram,and we found that the new predictive model was better at predicting 3-and 5-year overall survival than the latest TNM staging system.The C-index of the training cohort using the new model for survival prediction was 0.72,and the C-index of the training cohort using TNM staging system was only 0.64.The C-index of the validation cohort using the new model for survival prediction was 0.73,while the C-index of the validation cohort using TNM staging system was 0.63.The nomogram also displayed a good calibration.Conclusions The new predictive model with comprehensive prognostic factors is superior to the 8th TNM staging system in predicting overall survival of patients with Merkel cell carcinoma.This new model can help doctors to predict the prognosis of each patient more accurately,and assist clinical decision-making and individualized treatment.
作者
潘如菁
宣暄
侯李悦
刘晶晶
Pan Rujing;Xuan Xuan;Hou Liyue;Liu Jingjing(Department of Dermatology,First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)
出处
《中华内分泌外科杂志》
CAS
2020年第5期422-427,共6页
Chinese Journal of Endocrine Surgery
基金
国家自然科学基金(81703105)。
