摘要
目的探讨阴性淋巴结(NLNs)数目对新辅助治疗食管癌患者预后的预测价值及列线图预测模型构建。方法采用回顾性队列研究方法。收集2004—2015年美国国家癌症研究所监测、流行病学和最终结果数据库1924例新辅助治疗食管癌患者的临床病理资料;男1624例,女300例;年龄为63(23~85)岁。1924例患者通过R语言软件(3.6.2版本)随机数法以7∶3比例随机分为训练集1348例和验证集576例。训练集用于构建列线图预测模型,验证集用于验证列线图预测模型效能。应用X-tile软件(3.6.1版本)确定NLNs数目截断值为8枚和14枚,检出淋巴结(ELNs)数目截断值为10枚和14枚,并将其转化为分类变量。观察指标:(1)训练集和验证集患者临床病理特征。(2)训练集和验证集患者生存情况。(3)训练集患者预后因素分析。(4)训练集亚组患者生存情况。(5)训练集亚组患者预后因素分析。(6)构建列线图预测模型及校准曲线。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Mann-WhitneyU检验。计数资料以绝对数表示,组间比较采用χ^(2)检验。采用Kaplan-Meier法绘制生存曲线,Log-Rank检验进行生存分析。采用COX比例风险模型进行单因素和多因素分析。根据多因素分析结果构建列线图预测模型;应用受试者工作特征曲线的曲线下面积和Harrell′s c指数评估模型对患者预后的预测效能。应用校准曲线评估列线图预测模型在训练集和验证集中的生存预测误差。结果(1)训练集和验证集患者临床病理特征。1348例训练集和576例验证集患者临床病理特征比较,差异均无统计学意义(P>0.05)。(2)训练集和验证集患者生存情况。1924例患者随访时间为50(3~140)个月,3年和5年累积生存率分别为59.4%和49.5%。训练集NLNs数目<8枚、NLNs数目为8~14枚、NLNs数目>14枚患者3年累积生存率分别为46.7%、
Objective To investigate the value of number of negative lymph nodes(NLNs)in predicting the prognosis of patients with esophageal cancer after neoadjuvant therapy and the construction of nomogram prodiction model.Methods The retrospective cohort study was conducted.The clinicopathological data of 1924 patients with esophageal cancer after neoadjuvant therapy uploaded to the Surveillance,Epidemiology,and End Results Database of the National Cancer Institute from 2004 to 2015 were collected.There were 1624 males and 300 females,aged 63(range,23-85)years.All 1924 patients were randomly divided into the training dataset of 1348 cases and the validation dataset of 576 cases with a ratio of 7:3 based on random number method in the R software(3.6.2 version).The training dataset was used to constructed the nomogram prediction model,and the validation dataset was used to validate the performance of the nomogrram prediction model.The optimal cutoff values of number of NLNs and number of examined lymph nodes(ELNs)were 8,14 and 10,14,respectively,determined by the X-tile software(3.6.1 version),and then data of NLNs and ELNs were converted into classification variables.Observation indicators:(1)clinicopathological characteristics of patients in the training dataset and the validation dataset;(2)survival of patients in the training dataset and the validation dataset;(3)prognostic factors analysis of patients in the training dataset;(4)survival of patients in subgroup of the training dataset;(5)prognostic factors analysis in subgroup of the training dataset;(6)construction of nomogram prediction model and calibration curve.Measurement data with normal distribution were represented as Mean+SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was conducted using the Mann-Whitney U test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test.The Kaplan-Meier me
作者
杨月阳
唐鹏
于振涛
王海通
张洪典
马明全
乔宇峰
任鹏
刘向明
弓磊
Yang Yueyang;Tang Peng;Yu Zhentao;Wang Haitong;Zhang Hongdian;Ma Mingquan;Qiao Yufeng;Ren Peng;Liu Xiangming;Gong Lei(Department of Esophageal Oncology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy of Tianjin,Tianjin's Clinical Research Center for Cancer,Tianjin 300060,China;Department of Thoracic Surgery,Shenzhen Center,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,National Cancer Center,National Clinical Research Center for Cancer,Shenzhen 518116,Guangdong Province,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第3期371-382,共12页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81501994,81772619)
天津医科大学临床医学研究项目(2017kylc 008)
天津市肿瘤医院临床试验基金(C1711)
吴阶平医学基金会—卓越外科基金(320.2730.1886)
白求恩·爱惜康卓越外科基金(HZB-20190528-18,HZB-20190528-11)
天津市医学重点学科(专科)建设项目(TJYXZDXK-010A)。
关键词
食管肿瘤
阴性淋巴结
检出淋巴结
预后
列线图
Esophageal neoplasms
Negative lymph nodes
Examined lymph nodes
Prognosis
Nomogram
