胃神经内分泌瘤患者预后Nomogram预测模型的构建  

Construction of Nomogram prediction model for prognosis of gastric neuroendocrine neoplasms

作　　者：左倩倩 张彦兵[2] 马婕群 廖子君[2] 李倩 陈勇 ZUO Qianqian;ZHANG Yanbing;MA Jiequn;LIAO Zijun;LI Qian;CHEN Yong(Xi' an Medical University,Xi' an 710068,Shaanxi,China;Department of First Internal Medicine,Xi' an 710061,Shaanxi,China)

机构地区：[1]西安医学院,陕西西安710068 [2]西安交通大学医学院附属陕西省肿瘤医院内一科,陕西西安710061

出　　处：《中国肿瘤生物治疗杂志》2019年第5期569-576,共8页Chinese Journal of Cancer Biotherapy

摘　　要：目的:基于美国国立癌症研究所(NCI)的监测、流行病学和最终结果(SEER)数据库数据分析影响胃神经内分泌瘤(G-NEN)患者预后的相关因素,并构建Nomogram预测模型用于个体化预测G-NEN患者预后。方法:收集SEER数据库2010年至2015年有完整随访资料的2 720例G-NEN患者的临床数据,基于生存分析确定独立危险因素并构建Nomogram预测模型,采用一致性指数(C-index)和校准曲线评估模型准确性,采用受试者特征曲线下面积(AUC)比较该模型与第7版AJCC TNM分期评估法的预测价值。结果:2 720例G-NEN患者的1、3、5年生存率分别为88.14%、79.09%、71.86%。多因素COX回归分析显示,性别、年龄、婚姻状况、是否伴发其他肿瘤、组织学类型、肿瘤分级、T分期、M分期及是否手术是影响G-NEN患者生存时间的独立危险因素。新构建的Nomogram预测模型C-index为0.816,显著高于7版AJCC TNM分期评估法的0.702(P<0.001),且1、3、5年校准曲线显示预测生存率与实际生存率之间具有良好的一致性。新构建的Nomogram预测模型1、3、5年AUC分别为0.800、0.811及0.820,显著高于第7版AJCC TNM分期评估法的0.650、0.688及0.698(Z=6.600、8.058、9.632,均P<0.0001)。结论:构建的预测G-NEN患者预后的Nomogram模型具有较高的预测价值,能够个体化预测G-NEN患者的生存率,有助于临床治疗决策和临床研究方案的选择。Objection:To analyze the factors affecting the prognosis of patients with gastric neuroendocrine neoplasms(G-NENs)by using the surveillance of National Cancer Institute(NCI)of America,Epidemiology and End Results(SEER)database,and to construct a prognostic Nomogram model for individualized prediction of prognosis in patients with G-NENs.Methods:The clinical data of 2720 G-NENs patients with complete follow-up data from 2010 to 2015 in the SEER database were collected.The prognostic Nomogram model was constructed based on independent risk factors determined by survival analysis.The consistency index(C-index)and calibration curve were used to evaluate its accuracy.Area under the curve(AUC)was used to compare the evaluation value between the Nomogram and the 7 th edition of AJCC TNM staging.Results:The 1-,3-,and 5-year survival rates of 2,720 patients with G-NENs were88.14%,79.09%,and 71.86%,respectively.Multivariate COX regression analysis showed that gender,age,marital status,other associated tumors,histological type,tumor grade,T stage,M stage,and surgery were independent risk factors affecting survival time of GNENs patients.The C-index of newly constructed Nomogram prediction model was 0.816,which was significantly higher than 0.702 of the 7 th AJCC TNM staging(P<0.001),and the 1-,3-and 5-year calibration curves showed a good agreement between predicted survival and actual survival.The AUC for 1-,3-and 5-year survival by Nomogram prognostic model was 0.800,0.811,and 0.820,which was higher than 0.650,0.688 and 0.698 of the 7 th AJCC TNM staging,and the differences were statistically significant(Z=6.600,8.085,9.632,all P<0.0001).Conclusion:The Nomogram prediction model drawn in this study has a high prognostic value and can individually predict the survival rate of G-NENs patients,which is helpful for clinical treatment decision-making and clinical research options.

关 键 词：胃神经内分泌瘤 NOMOGRAM 预测模型 校准曲线 

分 类 号：R739.44[医药卫生—肿瘤] R730.7[医药卫生—临床医学]