摘要
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。
Background and objective Primary mediastinal germ cell tumor(PMGCT)is a rare but occasionally highly invasive mediastinal tumor.At present,there are few related disease special survival(DSS)studies on PMGCT,rare large data analysis,and uncommon DSS prognostic models.This study was to investigate the prognostic factors of DSS of the PMGCT patients,and build a simple and effective nomogram to predict the DSS prognosis in patients with PMGCT.Methods Retrospective clinicopathological data of 325 patients with PMGCT from 1975 to 2019 were extracted from Surveillance,Epidemiology,and End Results(SEER)database.The Kaplan-Meier method along with the Log-rank test were utilized to estimate the DSS.Cox proportional hazard regression model was used to screen the independent risk factors affecting prognosis,from which an individualized nomogram was constructed to predict 3-yr,5-yr and 8-yr DSS of patients with PMGCT.The prediction accuracy of the model is evaluated by receiver operating characteristic(ROC)curve,correction curve and decision curve analysis(DCA)curve.Results The 3-yr,5-yr and 8-yr survival rates of PMGCT were 84.6%,83.6%and 83.3%,respectively.Univariate analysis showed that histology,surgery,age,tumor size,metastasis and stage could affect the prognosis of PMGCT.Multivariate analysis showed that histology,surgery,age and tumor size were independent risk factors for the prognosis of PMGCT patients,and the nomogram was constructed using these independent risk factors.The area under the curve(AUC)of ROC curve was 0.824.The results of the correction curves of 3-yr,5-yr and 8-yr survival time and DCA,indicated that there was a good consistency between the predicted results of the nomogram evaluation and the real results.Conclusion Patients with histological classification of seminoma in PMGCT have a better prognosis than patients with non-seminoma.The prognosis of patients with over the age of 40 yr,tumor size≥15 cm and without surgical treatment was even worse.The nomogram model can accurately and intuitively pr
作者
郑祖强
吴中杰
胡奕
张雁飞
丁聪毅
邹昕锴
Zuqiang ZHENG;Zhongjie WU;Yi HU;Yanfei ZHANG;Congyi DING;Xinkai ZOU(Zhejiang Chinese Medical University,Hangzhou 310053,China;Department of Cardiothoracic Surgery,Jiaxing First Hospital,Jiaxing 314001,China)
出处
《中国肺癌杂志》
CAS
CSCD
北大核心
2023年第3期193-203,共11页
Chinese Journal of Lung Cancer
基金
2020年嘉兴市公益性研究计划项目(No.2020AD30073)
2020年度浙江省中医药科学研究基金项目(A类)(No.2020ZA114)资助。
关键词
原发性纵隔生殖细胞瘤
预后因素
SEER数据库
疾病特异性生存期
列线图
Primary mediastinal germ cell tumor
Prognostic factors
Surveillance,Epidemiology,and End Results database
Disease special survival
Nomogram Lasso regression
