儿童急性髓细胞白血病预后列线图模型的建立和验证  

Establishment and verification of a prognostic nomogram for childhood acute myeloid leukemia

作　　者：周金华 张晓筱 毛锐[1] 何庆[1] ZHOU Jinhua;ZHANG Xiaoxiao;MAO Rui;HE Qing(The Third People's Hospital of Chengdu Affiliated to Southwest Jiaotong University,Chengdu 610031,China;不详)

机构地区：[1]西南交通大学附属成都市第三人民医院重症医学科,成都610031 [2]四川大学华西公共卫生学院(华西第四医院)

出　　处：《山东医药》2021年第26期34-38,共5页Shandong Medical Journal

基　　金：四川省卫生和计划生育委员会科研课题(17PJ474)。

摘　　要：目的分析影响儿童急性髓细胞白血病(cAML)患儿预后的危险因素,构建预后列线图模型,并进一步验证该模型的预测价值。方法从TARGET数据库下载1068例cAML患儿数据,经筛选后纳入资料完整的样本839例。收集患儿的临床病理特征,包括年龄、性别、种族、存活状态、白细胞计数、中枢神经系统白血病、绿色瘤(粒细胞性肉瘤)等髓外侵犯疾病的患病状态、外周血母细胞数量、缓解状态、是否含有融合基因、异常染色体数目和结构改变。采用单因素Cox回归分析筛选与预后相关的因素,多因素Cox回归分析进一步筛选独立预后因素,建立列线图模型,对患儿3、5、7年的总生存期(OS)进行预测。列线图的预测准确性和判别能力通过一致性指数(C指数)、校准曲线以及ROC曲线下面积(AUC)确定,通过内部验证对列线图进行稳定性验证。结果多因素Cox回归分析显示,OS的独立影响因素为诊断时的白细胞计数、单体7,t(6;11)(q27;q23)、t(10;11)(p11.2;q23)、t(8;21)、inv(16)、NPM基因突变,以上述预测因子构建预后列线图。训练集所构建列线图的C指数为0.704(95%CI为0.677~0.731),预测3、5、7年生存率的AUC分别为0.701、0.709、0.708。内部验证集所构建列线图的C指数为0.702(95%CI为0.689~0.715),预测3、5、7年生存率的AUC分别为0.700、0.713、0.713。训练集与验证集的校准曲线均显示预测风险和实际发病风险较为一致。基于多因素Cox回归分析的回归系数计算风险评分,对训练集和验证集的患儿分别进行风险评分,Kaplan-Meier生存分析结果显示,训练集和验证集风险评分高的患儿OS均低于低风险评分患儿(P均<0.05)。结论cAML患儿诊断时的白细胞计数、单体7,t(6;11)(q27;q23)、t(10;11)(p11.2;q23)、t(8;21)、inv(16)、NPM基因突变是影响预后的相关因素;以上述预测因子构建预后列线图模型,可以客观、准确地预测cAML患儿的预后。Objective To explore the risk factors that affect the prognosis of children with acute myeloid leukemia(cAML),to construct a prognostic nomogram model and further to verify the predictive value of this model.Methods The data of 1068 children with cAML were downloaded from TARGET database,and 839 cases with complete data were included after screening.The clinicopathological features of the children were collected,including age,sex,race,surviv⁃al status,white blood cell count,central nervous system leukemia,whether there were extramedullary invasion diseases such as green tumor(chloroma),the number of peripheral blood mother cells,remission status,whether there were fusion genes,the number of abnormal chromosomes and structural changes.Univariate Cox regression analysis was used to screen the factors related to prognosis,and multivariate Cox regression analysis was used to further screen independent prognostic factors.A nomogram model was established to predict the overall survival(OS)of 3,5 and 7 years.The prediction accura⁃cy and discriminant ability of the nomogram model were determined by the concordance index(C index),the calibration curve,and the area under the ROC curve(AUC).The stability of the nomogram model was verified by internal verifica⁃tion.Results Multivariate Cox regression analysis showed that the independent influencing factors of OS were white blood cell count at diagnosis,monosomy-7,t(6;11)(q27;q23),t(10;11)(p11.2;q23),t(8;21),inv(16),and NPM mutation,and the nomogram model was successfully constructed based on the above predictors.The C index of the nomogram model constructed by the training set was 0.704(95%CI was 0.677-0.731),and the AUC values for predict⁃ing 3-,5-and 7-year survival rates were 0.701,0.709 and 0.708,respectively.The C index of the nomogram model con⁃structed by the internal verification set was 0.702(95%CI was 0.689-0.715),and the AUC values for predicting 3-,5-and 7-year survival rates were 0.700,0.713 and 0.713,respectively.The calibration curves of the training

关 键 词：儿童急性髓细胞白血病 危险因素 风险分层 预后列线图 

分 类 号：R733.7[医药卫生—肿瘤]