基于SEER数据库分析原发性气管恶性肿瘤的预后影响因素及Nomogram预测模型的构建  

Influencing factors for prognosis of primary tracheal malignancy and establishment of nomogram model for predicting its overall survival based upon SEER database

作　　者：颜维剑 赵晔 冯海明[1] 王成[1] 李斌[1] YAN Weijian;ZHAO Ye;FENG Haiming;WANG Cheng;LI Bin(Department of Thoracic Surgery,Lanzhou University Second Hospital,Lanzhou,730030,P.R.China;Department of Respiratory Medicine,Lanzhou University First Hospital,Lanzhou,730000,P.R.China)

机构地区：[1]兰州大学第二医院胸外科,兰州730030 [2]兰州大学第一医院呼吸内科,兰州730000

出　　处：《中国胸心血管外科临床杂志》2021年第5期545-554,共10页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：兰州市科技计划项目(2018-4-58)。

摘　　要：目的分析影响原发性气管恶性肿瘤患者预后的因素,并构建原发性气管恶性肿瘤患者预后的列线图(Nomogram)预测模型。方法选取1975~2016年美国国立癌症研究所的监测、流行病学和结果数据库(Surveillance,Epidemiology,and End Results,SEER)中病理学诊断为原发性气管恶性肿瘤的557例患者,分析其一般临床资料。通过单因素和多因素Cox回归分析筛选影响原发性气管恶性肿瘤患者预后的危险因素,采用R3.6.2软件对危险因素进行可视化分析并构建Nomogram预测模型,并通过计算一致性指数(C-index)、构建校准图和受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评价该模型的一致性和预测能力。结果557例原发性气管恶性肿瘤患者的中位生存期为21个月(95%CI 14.666~27.334),1年、3年和5年的肿瘤总生存率分别为59.1%±2.1%、42.5%±2.1%和35.4%±2.2%。单因素和多因素Cox回归分析显示年龄、组织学类型、手术方式、放射治疗、肿瘤大小、肿瘤浸润深度和淋巴结受累范围是影响原发性气管恶性肿瘤患者预后的独立危险因素(P<0.05)。基于以上7个危险因素通过可视化分析构建Nomogram预测模型,C-index为0.775(95%CI 0.751~0.799)。校准图显示本研究构建的预测模型1年、3年和5年预测生存率和实际生存率之间具有良好的一致性。ROC曲线结果显示1年、3年和5年的预测生存率曲线下面积(area under curve,AUC)分别为0.837、0.827和0.836,表明本模型具有较高的预测效能。结论基于多因素Cox回归分析构建的Nomogram预测模型有较好的预测能力,具有较高的区分度和精准度,临床价值高,对高危人群的筛选和个体化诊疗方案的制定具有重要意义,可作为原发性气管恶性肿瘤患者预后监测的一种评价工具。Objective To analyze the factors affecting the prognosis of patients with primary tracheal malignancy,and establish a nomogram model for prediction its prognosis.Methods A total of 557 patients diagnosed with primary tracheal malignancy from 1975 to 2016 in the Surveillance,Epidemiology,and End Results Data were collected.The factors affecting the overall survival rate of primary tracheal malignancy were screened and modeled by univariate and multivariate Cox regression analysis.The nomogram prediction model was performed by R 3.6.2 software.Using the C-index,calibration curves and receiver operating characteristic(ROC)curve to evaluate the consistency and predictive ability of the nomogram prediction model.Results The median survival time of 557 patients with primary tracheal malignancy was 21 months,and overall survival rates of the 1-year,3-year and 5-year were 59.1%±2.1%,42.5%±2.1%,and 35.4%±2.2%.Univariate and multivariate Cox regression analysis showed that age,histology,surgery,radiotherapy,tumor size,tumor extension and the range of lymph node involvement were independent risk factors affecting the prognosis of patients with primary tracheal malignancy(P<0.05).Based on the above 7 risk factors to establish the nomogram prediction model,the C-index was 0.775(95%CI 0.751-0.799).The calibration curve showed that the prediction model established in this study had a good agreement with the actual survival rate of the 1 year,3 year and 5 years.The area under curve of 1-year,3-year and 5-year predicting overall survival rates was 0.837,0.827 and 0.836,which showed that the model had a high predictive power.Conclusion The nomogram prediction model established in this study has a good predictive ability,high discrimination and accuracy,and high clinical value.It is useful for the screening of high-risk groups and the formulation of personalized diagnosis and treatment plans,and can be used as an evaluation tool for prognostic monitoring of patients with primary tracheal malignancy.

关 键 词：原发性气管恶性肿瘤 监测、流行病学和结果数据库(SEER) 预后模型 列线图 

分 类 号：R734.1[医药卫生—肿瘤]