成人脑室胶质瘤患者预后列线图模型的构建与评价  

Development and Evaluation of Prognostic Nomogram Model for Adult Ventricle Glioma Patients

作　　者：张昊东方 牛小东[1] 周兴旺[1] 杨渊[1] 李焦明 甘有均 王翔[1] 刘艳辉[1] 毛庆[1] ZHANG Hao-dong-fang;NIU Xiao-dong;ZHOU Xing-wang;YANG Yuan;LI Jiao-ming;GAN You-jun;WANG Xiang;LIU Yan-hui;MAO Qing(Department of Neurosurgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Neurosurgery,Sichuan Cancer Hospital,Chengdu 610042,China;Department of Neurosurgery,Medical Center Hospital of Qionglai City,Qionglai 611530,China)

机构地区：[1]四川大学华西医院神经外科,成都610041 [2]四川省肿瘤医院神经外科,成都610042 [3]邛崃市医疗中心医院神经外科,邛崃611530

出　　处：《四川大学学报（医学版）》2022年第4期588-596,共9页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探究成人脑室胶质瘤(adult ventricle glioma,AVG)患者的预后因素,进一步构建和评价预后列线图模型,为该类患者的临床管理提供一定的参考。方法本研究纳入SEER数据库(1973–2016)中经组织学明确诊断的AVG患者,用随机数字表法按2∶1比例分为训练集和验证集进行分析。使用Kaplan-Meier进行生存分析,Cox回归分析确定总生存(OS)和癌症特异性生存(CSS)的独立预后因素,结合患者基本特征,分别构建训练集中针对OS率和CSS率的生存相关列线图预测模型,再依次通过训练集和验证集进行模型的内部交叉验证和外部验证。C指数(C-index)用来评估列线图模型的真实性和可靠性,校准图用来评估训练集和验证集中预测值和观察值之间的一致性。结果本研究共纳入369例AVG患者,其中男性218例,女性151例,所有患者中位年龄为53岁。根据WHO分级,66例(17.9%)为Ⅱ级胶质瘤,73例(19.8%)为Ⅲ级胶质瘤,230例(62.3%)为Ⅳ级胶质瘤。根据手术切除程度,59例(16.0%)为肿瘤全切,145例(39.3%)为次全切或部分切除。所有患者中,167例(45.3%)术后接受了放疗,143例(38.8%)术后接受了化疗。患者随机分为训练集(n=246)和验证集(n=123),训练集和验证集之间的基本临床特征的差异均无统计学意义(P>0.05)。训练集中Cox回归分析显示,年龄≥65岁、肿瘤分级III级和Ⅳ级、未接受放疗均是OS和CSS的独立预后因素。在训练集中,使用5个变量(年龄、性别、WHO分级、手术和放疗)分别构建用于预测术后6个月、1年和2年OS率和CSS率的列线图模型。训练集内部交叉验证结果显示,OS率和CSS率的C指数分别为0.758和0.765;验证集外部验证结果显示,OS率和CSS率的C指数分别为0.733和0.719。训练集中6个月、1年和2年OS率的校准图均表现出良好的一致性,而在验证集中一致性相对较低。6个月、1年和2年CSS率的校准图与OS率校准图具有相似的结果。结论OS率�Objective To explore the prognostic factors of adult ventricle glioma(AVG)and to construct and evaluate a survival-related prognostic nomogram model,which could provide further reference for the clinical management of AVG patients.Methods The patients covered in the study were selected from the Surveillance Epidemiology and End Results(SEER)database(1973–2016).They all had definite histological diagnosis of AVG.They were assigned randomly to the training cohort and the validation cohort by random number table at a 2/1 ratio.Survival analysis was performed by Kaplan-Meier analysis.Cox regression analysis was employed to determine the independent prognostic factors for overall survival(OS)and cancer-specific survival(CSS).Then,integrating the basic characteristics of patients,the survival-related nomogram predictive model for OS and CSS in the training cohort was constructed,respectively.After that,internal cross validation and external validation of the model were carried out with the training cohort and the validation cohort in succession.The authenticity and reliability of the nomogram model were evaluated by calculating the concordance index(C-index).Calibration plots were constructed to assess the agreement between the predicted values and the observed values in the training cohort and the validation cohort.Results A total of 369 AVG patients,including 218 males and 151 females,were included.The median age of the patients was 53.According to the WHO classification of gliomas,66(17.9%)patients had gradeⅡgliomas,73(19.8%)had gradeⅢgliomas,and 230(62.3%)had gradeⅣgliomas.Regarding the extent of resection(EOR),59(16.0%)had gross total resection(GTR)and145(39.3%)had subtotal resection(STR)or partial resection(PR).Of all the patients,167(45.3%)received postoperative radiotherapy and 143(38.8%)received postoperative chemotherapy.Patients were randomized into the training cohort(n=246)and the validation cohort(n=123),and there was no significant difference(P>0.05)in the basic clinical characteristics between t

关 键 词：脑室胶质瘤 列线图 预后模型 SEER 总生存期 癌症特异性生存期 

分 类 号：R739.41[医药卫生—肿瘤]