基于SEER数据库男性乳腺癌手术切除病人预后分析及列线图建立  

Prognostic analysis and nomogram development of male breast cancer patients undergoing surgical resection:Based on SEER database

作　　者：余军林 余幼林 YU Jun-lin;YU You-lin(Department of Oncology,Xiaogan Hospital Affiliated Wuhan University of Science and Technology,Xiaogan 432000,China;不详)

机构地区：[1]武汉科技大学附属孝感医院肿瘤科,湖北孝感432000 [2]武汉科技大学附属孝感医院甲乳外科,湖北孝感432000

出　　处：《中国实用外科杂志》2021年第11期1269-1276,共8页Chinese Journal of Practical Surgery

基　　金：湖北省卫生计生委联合基金项目(No.WJ2018H0098)。

摘　　要：目的分析男性乳腺浸润性导管癌手术切除病人的独立预后因素及构建预后列线图,同时验证该模型的准确性。方法从美国国立癌症研究监测、流行病学和最终结果(SEER)数据库中下载2010—2018年间诊断为男性乳腺浸润性导管癌且经过手术切除的1662例病人的临床病理特征及治疗信息。随机数字分组法将病人按照3∶1分为训练队列(1246例)和验证队列(416例)。通过单因素及多因素COX分析筛选出独立预后因素并构建预测1、3、5年的总生存率(OS)的列线图。一致性指数(c-指数)和校准曲线确定列线图预测的准确性和判别能力。结果年龄、肿瘤直径、临床TNM、病理学分级、婚姻状态5个指标均是OS的独立预后因素(P均<0.05)。基于独立预后因素构建了1、3、5年OS的列线图。训练队列中列线图的c-指数为0.730(95%CI 0.694-0.766),高于美国癌症联合委员会(AJCC)临床TNM分期系统0.628(95%CI 0.588-0.668);验证队列列线图的c-指数为0.737(95%CI 0.680-0.794),高于AJCC临床TNM分期系统0.584(95%CI 0.516-0.652)。校准曲线表明列线图预测生存率与实际生存率具有良好的一致性。结论基于年龄、肿瘤直径、临床TNM、病理学分级、婚姻状态的独立预后因素构建的列线图能较准确地显示男性乳腺癌手术切除病人预后,有利于进行临床个体化预后评估。Objective To analyze the independent prognostic factors of male patients with infiltrating duct breast cancer undergoing surgical resection and develop a prognostic nomogram to further verify the accuracy of prediction.Methods The clinicopathological characteristics and treatment status of 1662 male patients pathologically diagnosed as infiltrating duct breast cancer and undergoing surgical resection from 2010 to 2018 were collected from the SEER database.All patients were divided into training cohort(n=1246)and validation cohort(n=416)according to 3∶1 by random number grouping method.Independent prognostic factors were screened out to develop a nomogram prognostic model to predict 1-,3-,and 5-years overall survival(OS)by univariate analysis and multivariate cox analysis.The predictive accuracy and discriminative ability of the nomogram were evaluated by the consistency index(c-index)and the calibration curve.Results The five indicators including age,tumor diameter,clinical TNM,pathological grade,marital status are independent prognostic factors of OS(all P<0.05).A predictive nomogram model of 1,3,and 5 years OS was developed by independent prognostic factors.The c-index of the nomogram in the training cohort is 0.730(95%CI 0.694-0.766),which is higher than the American Joint Committee on Cancer(AJCC)clinical TNM staging system by 0.628(95%CI:0.588-0.668);the c-index of the nomogram in the validation cohort is 0.737(95%CI 0.680-0.794),which is higher than the AJCC clinical TNM staging system by 0.584(95%CI 0.516-0.652).The calibration curve shows that the predicted survival rate of the nomogram is in good agreement with the actual survival rate.Conclusion A nomogram constructed based on independent prognostic factors including age,tumor diameter,clinical TNM,pathological grade,and marital status can more accurately predict the prognosis of male breast cancer patients undergoing surgical resection,which is beneficial to clinically individualized patient prognosis evaluation.

关 键 词：男性乳腺癌 SEER数据库 预后 列线图 

分 类 号：R6[医药卫生—外科学]