骨肉瘤预后个体化预测模型列线图的建立  

Establishment and assessment of a nomogram for predicting the individual prognosis of osteosarcoma

作　　者：黄纲[1,2] 董忠信 谢显彪[1] 尹军强[1] 邹昌业[1] 王永谦[1] 王晋[1] 沈靖南[2] 

机构地区：[1]中山大学附属第一医院骨肿瘤科,广州510080 [2]南华大学附属南华医院骨科

出　　处：《中华骨科杂志》2015年第2期133-141,共9页Chinese Journal of Orthopaedics

基　　金：广东省自然科学基金（S2013010015384）;中山大学临床研究5010计划（180009）

摘　　要：目的 通过对骨肉瘤患者的临床、病理学、影像学及随访资料进行预后因素分析,建立骨肉瘤预后预测模型列线图,并验证其准确度.方法 收集1998至2008年确诊且符合入组标准的235例骨肉瘤患者组成建模组,2009年的55例骨肉瘤患者组成验证组.单因素生存分析采用Kaplan-Meier法绘制生存曲线,Log-rank法进行统计学分析;应用Cox比例风险模型进行多因素分析,确定独立预后因子;然后应用R软件建立预测模型列线图,内部验证运用Bootstrap法,外部验证运用验证组,一致性指数（C-index）用来评价模型准确度,并绘制出列线图预测和实际观察的五年生存率校准曲线.结果 建模组和验证组五年总体生存率分别为46.1％±6.7％和61.8％±12.9％.多因素分析结果显示,病理性骨折、入院时碱性磷酸酶水平、肿瘤大小、肿瘤分期和术后化疗次数是独立预后因素.校准曲线显示列线图预测与实际观察的五年生存率有很好的一致性.列线图预测五年生存率的C-index为0.74（95％CI,0.70～0.78）,明显高于Enneking分期系统.应用验证组进行外部验证,列线图、Enneking分期和美国癌症联合委员会（AJCC）分期系统的C-index分别为0.71、0.54和0.56,提示列线图比Enneking分期及AJCC分期的预后预测准确性更高.结论 成功建立的预测骨肉瘤患者总体生存列线图能实现个体化预测,且与其他预后预测系统相比更直观、准确.Objective To develop an accurate prognostic nomogram for osteosarcoma and to validate it in order to provide scientific basis for risk evaluation,though analyzing the clinicopathologic,radiologic and follow-up data of osteosarcoma patients.Methods All of 235 osteosarcoma patients who diagnosed in the department of Musculoskeletal Oncology in the first affiliated hospital of Sun Yat-Sen University during 1998 to 2008 and met the inclusion criteria,were included in a primary cohort,and 55 patients diagnosed in 2009 were included in a validation cohort.In univariate survival analysis of the primary cohort,Kaplan-Meier method was used to plot Survival curves,and the log-rank test to compare differences.In the multivariate analysis,the Cox proportional hazard model had been used to identify the independent prognostic factors.Then a nomogram created by R software was validated by Bootstrap resampling as internal validation and by the validation cohort as external validation.Concordance index （C-index） was applied to the predictive evaluation of the nomogram and calibration curves were drawn to test the nomogram-prediction and actual observation of the five-year overall survival rate.Results The five-year overall survival rates of the primary cohort and validation cohort were 46.1%±6.7% and 61.8% ± 12.9%,respectively.In multivariate analysis,pathologic fracture,pre-ALP,tumor maximum diameter,Enneking stage and postoperative chemotherapy had been identified as independent prognostic factors.Good concordance of survival probability between nomogram-prediction and actual observation was shown by the calibration curves.The C-index of the nomogram for predicting survival,0.74（95% CI,0.70-0.78）,was statistically higher than that of the Enneking system （C-index：0.54）.Of the validation cohort,C-index of the nomogram,Enneking and American Joint Committee on Cancer （AJCC） stage system was 0.71,0.54 and 0.56,respectively,indicating the nomogram had a higher accuracy in prognostic prediction than the others.Conc

关 键 词：骨肉瘤 列线图 预后 

分 类 号：R738.1[医药卫生—肿瘤]