基于AJCC TNM分期建立中晚期甲状腺髓样癌术后生存的列线图模型:SEER数据库分析  

Nomogram of survival after surgery for intermediate to advanced medullary thyroid cancer based on AJCC TNM staging:a SEER database analysis

作　　者：唐豪佑 唐云辉 贺鑫 王芳 任章霞 TANG Haoyou;TANG Yunhui;HE Xin;WANG Fang;REN Zhangxia(Department of Thyroid and Breast Surgery,West China-Guang’an Hospital of Sichuan University,Guang’an,Sichuan 638500,P.R.China)

机构地区：[1]四川大学华西广安医院甲状腺乳腺外科,四川广安638500

出　　处：《中国普外基础与临床杂志》2023年第8期944-950,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：广安市人民医院2021年高质量发展基金项目(项目编号:21FZ010)。

摘　　要：目的 利用美国监测、流行病学和结果数据库(the Surveillance, Epidemiology, and End Results,SEER)建立基于美国癌症联合委员会(American Joint Committee on Cancer,AJCC)TNM分期的中晚期甲状腺髓样癌(medullary thyroid cancer,MTC)患者术后长期肿瘤特异性生存的预测模型。方法 通过筛选2004–2017年期间SEER数据库中登记的中晚期MTC接受甲状腺全切除及颈部淋巴结清扫手术的692例患者的数据,按7∶3随机分为建模组484例和验证组208例。采用Cox比例风险回归筛选中晚期MTC术后肿瘤特异性生存的预测因素并建立列线图模型,利用一致性指数(C-index)、校准曲线、时间依赖性ROC曲线及决策曲线分析(decision curve analysis,DCA)检验模型的准确性及实用性。结果 在建模组中,多因素Cox比例风险回归模型表明,影响中晚期MTC术后肿瘤特异性生存的因素为AJCC TNM分期、年龄、淋巴结比值(lymph node ratio,LNR)和肿瘤直径,据此结果建立列线图模型。建模组中,该模型的C指数为0.827,5年和10年时间依赖性ROC曲线下面积分别为0.865 [95%CI(0.817,0.913)]和0.845 [95%CI(0.787,0.904)];验证组中,该模型的C指数为0.866,5年和10年时间依赖性ROC曲线下面积分别为0.866 [95%CI(0.798,0.935)]和0.923 [95%CI(0.863,0.983)]。在建模组和验证组中,该模型预测的5年和10年肿瘤特异性生存率与实际的5年和10年肿瘤特异性生存率具有良好的一致性;DCA曲线表明建立的基于AJCC TNM分期的列线图模型与仅含AJCC TNM分期模型相比较,前者在患者术后5年和10年获得的净收益具有明显优势。结论 本研究建立的基于AJCC TNM分期的预测中晚期MTC术后肿瘤特异性生存的预后模型具有较好的预测效果和实用性,有助于指导个性化、精准、全面的治疗决策,可用于临床实践中。Objective To establish a predictive model for long-term tumor-specific survival after surgery for patients with intermediate to advanced medullary thyroid cancer(MTC)based on American Joint Committee on Cancer(AJCC)TNM staging,by using the Surveillance,Epidemiology,and End Results(SEER)Database.Methods The data of 692 patients with intermediate to advanced MTC who underwent total thyroidectomy and cervical lymph node dissection registered in the SEER database during 2004–2017 were extracted and screened,and were randomly divided into 484 cases in the modeling group and 208 cases in the validation group according to 7∶3.Cox proportional hazard regression was used to screen predictors of tumor-specific survival after surgery for intermediate to advanced stage MTC and to develop a Nomogram model.The accuracy and usefulness of the model were tested by using the consistency index(C-index),calibration curve,time-dependent ROC curve and decision curve analysis(DSA).Results In the modeling group,the multivariate Cox proportional hazard regression model indicated that the factors affecting tumor-specific survival after surgery in patients with intermediate to advanced MTC were AJCC TNM staging,age,lymph node ratio(LNR),and tumor diameter,and the Nomogram model was developed based on these results.The modeling group had a C-index of 0.827 and its area under the 5-year and 10-year time-dependent ROC curves were 0.865[95%CI(0.817,0.913)],0.845[95%CI(0.787,0.904)],respectively,and the validation group had a C-index of 0.866 and its area under the 5-year and 10-year time-dependent ROC curves were 0.866[95%CI(0.798,0.935)]and 0.923[95%CI(0.863,0.983)],respectively.Good agreement between the model-predicted 5-and 10-year tumor-specific survival rates and the actual 5-and 10-year tumorspecific survival rates were showed in both the modeling and validation groups.Based on the DCA curve,the new model based on AJCC TNM staging was developed with a significant advantage over the former model containing only AJCC TNM staging in te

关 键 词：甲状腺髓样癌 SEER数据库 AJCC TNM分期 肿瘤特异性生存 列线图 

分 类 号：R736.1[医药卫生—肿瘤]