肌层浸润性上尿路上皮癌患者术后生存因素分析及预后模型构建  

Survival factors analysis and prognostic model construction in patients with muscle invasive upper tract urothelial carcinoma

作　　者：彭红亮 兰东阳 张学冲[1] 杨振[1] 刘秉乾[1] 武玉东[1] PENG Hongliang;LAN Dongyang;ZHANG Xuechong;YANG Zhen;LIU Bingqian;WU Yudong(Department of Urology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科,河南郑州450052

出　　处：《现代泌尿外科杂志》2021年第11期943-949,共7页Journal of Modern Urology

摘　　要：目的探讨肌层浸润性上尿路尿路上皮癌(UTUC)术后影响患者生存的因素,构建生存列线图并评估其预测效能。方法回顾性分析美国国立癌症研究所建立的SEER数据库中UTUC患者信息,分析筛选出影响生存预后的临床病理因素,绘制列线图,计算C指数(C-index)和NRI值评估模型区分度,绘制校准图检验其精准度,决策曲线(DCA)及决策树模型评价模型临床有效性。结果筛选出的因素有:诊断年龄、原发部位、T分期、M分期、肿瘤最大径,将其纳入构建列线图,经内部验证,列线图的C指数为0.726,相较于单纯的TNM分期有明显提升,校准图显示预测结果与实际结果有良好的一致性。结论列线图相较于TNM分期能更好预测肌层浸润性UTUC患者的预后生存,为实施个体化诊疗方案及干预措施提供参考。Objective To explore the influencing factors of postoperative survival in patients with muscle invasive upper tract urothelial carcinoma(UTUC),to establish a nomogram to predict the prognostic survival and to evaluate its predictive power.Methods The basic information of UTUC patients in the SEER(The Surveillance,Epidemiology,and End Results,SEER)database established by the National Cancer Institute in the United States was retrospectively analyzed.The clinical and pathological factors were analyzed and screened out to develop a nomogram and its verification diagram.The C-index and NRI values were calculated to evaluate the discrimination of the new model,and calibration curves were generated to evaluate the prediction accuracy.DCA curves and decision tree model were used to evaluate the clinical validity of the new model.Results The diagnostic age,primary site,T stage,M stage,and maximum tumor diameter were included in the construction of the nomogram.After internal verification,the C-index of the nomogram was 0.726,which was a significant improvement compared to the TNM staging system.The calibration curves directly showed that the predicted results were in good agreement with the actual results.Conclusion Compared with TNM staging,the nomogram can better predict the prognosis and survival of patients with muscle invasive UTUC,and provide reference for individualized diagnosis and treatment plans.

关 键 词：上尿路尿路上皮癌 根治性肾输尿管切除术 预后分析 列线图 生存预测 

分 类 号：R737.1[医药卫生—肿瘤]