基于SEER数据库的口底鳞状细胞癌特异性预后分析及列线图模型构建  

Nomograms for predicting cancer-specific survival of patients with floor of mouth squamous cell carcinoma:a population-based study

作　　者：左怡洁 闵安杰[1] 胡传宇 汪伟明[1] ZUO Yi-jie;MIN An-jie;HU Chuan-yu;WANG Wei-ming(Department of Stomatology,Xiangya Hospital of Central South University,Hunan Changsha 410000,China;Department of Oral and Maxillofacial Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430030,China)

机构地区：[1]中南大学湘雅医院口腔医学中心,湖南长沙410000 [2]华中科技大学同济医学院附属同济医院口腔颌面外科,湖北武汉430030

出　　处：《临床口腔医学杂志》2021年第6期339-344,共6页Journal of Clinical Stomatology

基　　金：国家自然科学基金项目(81702708)。

摘　　要：目的:应用SEER数据库收集口底鳞状细胞癌(floor of mouth squamous cell carcinoma,FOM-SCC)患者的临床病理资料并进行统计分析和列线图(nomogram)模型构建。方法:下载2004~2015年间美国SEER数据库中FOM-SCC患者临床病理信息和随访资料。采用Cox回归模型获取影响患者预后的独立因素并构建列线图,用于预测口底鳞癌患者3年、5年以及8年的特异性生存率。随后采用一致性指数(concordance index,C-index)、ROC曲线图(receiver-operating characteristic curves,ROC)、校准图、重分类改善指数(the net reclassification improvement,NRI)、综合判别改善指数(the integrated discrimination improvement,IDI)和决策曲线分析(decision curve analyses,DCA),验证预测模型的区分度、一致性、预测效能以及临床应用价值。结果:共纳入3915例FOM-SCC患者,其中建模组2740例,验证组1175例。多因素分析结果表明年龄、婚姻状况、AJCC分期、TNM分期、是否手术、是否行放疗和化疗是影响FOM-SCC患者预后的重要临床病理因素。成功构建了个体化预测FOM-SCC患者生存率的列线图,一致性指数、AUC以及校准图分析结果显示列线图具有良好的区分度。NRI和IDI结果表明,列线图的预测效能高于AJCC分期系统。建模组和验证组在3年、5年以及8年的预测净收益均高于AJCC分期系统。结论:建立并验证了FOM-SCC患者预后列线图,其评估效果优于AJCC分期系统。研究列线图对临床实践意义深远,可以通过查阅患者信息,评估他们在未来3年、5年和8年的预后效果。Objective:To collect clinicopathological data of patients with the Floor of mouth squamous cell carcinoma(FOM-SCC)by Surveillance,Epidemiology,and End Results(SEER)database which were statistically analyzed and used to construct nomogram.Methods:To download clinicopathological information and follow-up data of FOM-SCC patients in SEER database from 2004 to 2015.The independent prognostic factors were obtained by Cox regression model and nomogram was constructed to predict the 3-year,5-year and 8-year specific survival rate of patients with FOM-SCC.Several basic features of model validation were used to evaluate the performance of our survival model,the concordance index(C-index),time-dependent receiver-operating characteristic curves(ROC),calibration plots,the net reclassification improvement(NRI),the integrated discrimination improvement(IDI)and decision curve analyses(DCA).Results:A total of 3915 patients with FOM-SCC were included in this study.Patient were assigned as trainning set(n=2740),and the rest were selected as SEER validation set(n=1175).The multivariate analyses demonstrated that age,marital status,AJCC stage,TNM stage,surgery,radiotherapy,and chemotherapy were risk factors for survival.In particular,C-index,AUC and the calibration plots showed good performance of the nomogram.Compared to AJCC system,NRI and IDI showed that the nomogram has improved performance.Finally,the nomogram’s 3-year and 5-year and 8-year DCA curves yield net benefits higher than traditional AJCC,whether training set or a validation set.Conclusion:We developed and validated FOM-SCC prognosis nomogram for the first time.The prognostic value of the nomogram is better than that of the AJCC staging system alone.In addition,the nomogram of this study is a valuable tool for clinical practice to consult patients to understand their risk for the next 3 years,5 years and 8 years.

关 键 词：列线图 SEER数据库 口底鳞状细胞癌 肿瘤特异性生存率 

分 类 号：R739.8[医药卫生—肿瘤]