基于SEER数据库构建的远处转移性乳腺癌的预后列线图  

Prognostic nomogram for metastatic advanced breast cancer constructed based on SEER data

作　　者：章锐 阮剑[1] 赵建国[1] ZHANG Rui;RUAN Jian;ZHAO Jianguo(Department of Thyroid and Breast Surgery,Wuhan No.1 Hospital,Wuhan,Hubei 430000,China)

机构地区：[1]武汉市第一医院甲状腺乳腺外科,湖北武汉430000

出　　处：《安徽医药》2022年第9期1781-1785,共5页Anhui Medical and Pharmaceutical Journal

基　　金：湖北省卫生健康科研基金资助项目(WJ2021M001);武汉市卫生健康科研基金资助项目(WX20B10)。

摘　　要：目的构建远处转移性乳腺癌的有效预后列线图。方法从SEER(The Surveillance,Epidemiology,and End Results)数据库中筛选到2010年1月至2012年12月诊断为远处转移性乳腺癌的3989例病人,采用整群随机抽样法分为建模组(n=2993)和验证组(n=996),使用Cox比例风险回归模型分析建模组预后独立危险因素,并构建预后列线图,利用内部自助重取样和验证组病人验证结果,列线图的预测准确性和判别能力由C指数和校准曲线确定。结果在对建模组病人的多因素分析中,生存的独立危险因素如年龄、婚姻状态、种族、组织学分级、雌激素受体(ER)状态、孕激素受体(PR)状态、人表皮生长因子受体2(Her-2)状态、T分期、原发灶手术、骨转移、脑转移、肝转移和肺转移都被选入列线图。生存概率的校准曲线显示出列线图预测良好的一致性,列线图预测生存的C指数为0.702[95%CI:(0.696,0.708)],在验证队列中,列线图的C指数为0.707[95%CI:(0.706,0.708)]。结论该列线图可以为远处转移性乳腺癌病人提供较为准确的预后预测。Objective To construct and validate an effective prognostic nomogram for metastatic advanced breast cancer.Methods The nomogram was based on 3989 patients who were diagnosed with metastatic advanced breast cancer from January 2010 to Decem-ber 2012 in SEER(The Surveillance,Epidemiology,and End Results)program data.The data was assigned into the training group(n=2993)and the validation group(n=996)by random sampling.The Cox proportional hazard regression model was performed to identify the independent risk factors affecting prognosis of the training group,and the prognostic mnomogram was constructed.The results were in-ternally validated using bootstrap resampling and externally with the validation group,the predictive accuracy and discriminative abili-ty of the nomogram were determined by concordance index(C-index)and calibration curve.Results On multivariate analysis of the training group,independent factors for survival were age,marital status,race and grade,estrogen receptor(ER)status,progesterone re-ceptor(PR)status,human epidermal Growth factor receptor 2(Her-2)status,stage T,surgery of primary site,bone metastasis,brain mtetastasis,liver metastasis and lung metastasis,which were all selected into the nomogram.The calibration curve for probability of sur-vival showed good agreement between prediction by nomogram,the C-index of the nomogram for predicting survival was 0.702[95%CI:(0.696,0.708)].In the validation group,the C-index of nomogram discrimination was 0.707[95%CI:(0.706,0.708)].Conclusion The nomogram can provide more accurate prognosis prediction for patients with metastatic advanced breast cancer.

关 键 词：乳腺肿瘤 肿瘤转移 列线图 生存 SEER数据库 预后 

分 类 号：R737.9[医药卫生—肿瘤]