淋巴结阳性肾盂尿路上皮癌疾病特异性生存模型的构建  

Construction of a nomogram predicting disease-specific survival for patients with lymph node metastatic urothelial carcinoma of the renal pelvis

作　　者：侯广东 郑昱 刘鹏飞[1] 王福利[1] 魏迪 倪建鑫 来东 袁建林[1] HOU Guangdong;ZHENG Yu;LIU Pengfei;WANG Fuli;WEI Di;NI Jianxin;LAI Dong;YUAN Jianlin(Department of Urology, Xijing Hospital of the Air Force Medical University, Xi'an 710032, China)

机构地区：[1]中国人民解放军空军军医大学西京医院泌尿外科,西安710032

出　　处：《临床肿瘤学杂志》2020年第8期724-729,共6页Chinese Clinical Oncology

摘　　要：目的探讨淋巴结阳性肾盂尿路上皮癌(UCRP)患者疾病特异性生存率(DSS)的独立预测因素,并构建专门的列线图模型以个体化预测其确诊后1、2、3年DSS。方法回顾性分析2004年1月至2016年12月在SEER数据库中登记的UCRP患者的一般资料,采用Kaplan-Meier法计算患者的总体生存率(OS)和DSS,采用Log-rank检验衡量不同亚组间的生存差异,采用Cox比例风险回归模型分析影响DSS的独立因素,并运用R软件整合所有具有独立预测意义的变量绘制列线图模型。通过计算受试者工作特征(ROC)曲线下面积(AUC)并绘制校准曲线对模型的预测性能进行验证。结果Cox多因素回归分析显示,确诊时的年龄>75岁、肿瘤最大直径>75 mm、T3~T4期、N3期及M1期是淋巴结阳性UCRP患者DSS的独立危险因素;辅助化疗是独立保护因素。经内部验证,模型预测淋巴结阳性UCRP患者1、2、3年DSS的区分度分别为0.792、0.764、0.750。校准曲线证实模型预测的1、2、3年DSS与实际生存结果均具有良好的符合度。结论本研究确定了与淋巴结阳性UCRP患者DSS独立相关的因素,并为该类患者构建了国内外首个专门的DSS个体化预测模型。Objective To explore the independent predictors of disease-specific survival(DSS)in patients with lymph node metastatic urothelial carcinoma of the renal pelvis(UCRP),and to establish a nomogram for predicting the 1-,2-and 3-year DSS exclusive for them.Methods The data of lymph node metastatic UCRP patients registered in the SEER database from January 2004 to December 2016 was retrospectively analyzed.The Kaplan-Meier method was used to calculate overall survival(OS)and DSS,and the Log-rank test was used to test survival differences among different subgroups.Independent predictors of DSS were determined by Cox univariate and subsequent multivariate regression analysis,and our nomogram was developed using R software by integrating all variables with independent predictive significance.Moreover,the performance of our nomogram was measured by calculating values of area under the receiver operating characteristic curve(ROC)and generating calibration curves.Results Cox multivariate regression analysis showed that age at diagnosis>75 years,maximum tumor diameter>75 mm,stage T3 and T4,stage N3 and stage M1 were identified as the independent risk factors for DSS,while adjuvant chemotherapy was an independent protective factor.The discriminatory performance of the nomogram for predicting 1-,2-,and 3-year DSS was 0.792,0.764 and 0.750,respectively.Besides,calibration plots showed good consistency between the predicted and actual 1-,2-,and 3-year DSS.Conclusion In the current study,independent predictors of DSS were identified and the first nomogram for predicting individual DSS was constructed for patients with lymph node metastatic UCRP.

关 键 词：肾盂癌 尿路上皮癌 淋巴结转移 预后 列线图 

分 类 号：R737.11[医药卫生—肿瘤]