舌鳞状细胞癌根治性切除术后患者预后预测列线图的构建与验证  

Establishment and verification of a prognostic nomogram for survival of tongue squamous cell carcinoma patients who underwent cervical dissection

作　　者：苏俊琪[1] 王晓颖[2] 孙志强 SU Junqi;WANG Xiaoying;SUN Zhiqiang(Department of Clinical Laboratory,Peking University School and Hospital of Stomatology&National Center for Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices,Beijing 100081,China;Department of Medical Record,Peking University School and Hospital of Stomatology&National Center for Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院检验科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,北京100081 [2]北京大学口腔医学院·口腔医院病案管理科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,北京100081

出　　处：《北京大学学报（医学版）》2024年第1期120-130,共11页Journal of Peking University:Health Sciences

摘　　要：目的:评估术前炎症生物标志物、预后营养指数和临床病理特征对舌鳞状细胞癌(tongue squamous cell carcinoma,TSCC)患者行根治性切除术后生存结局的预后价值,并以此构建患者预后预测列线图模型。方法:回顾性收集2017年1月至2018年7月于北京大学口腔医院接受根治性肿瘤切除术的297例TSCC患者的病例资料,随机按照7∶3比例分为训练集和验证集。分析患者术前全身炎症反应标志物中性粒细胞/淋巴细胞比率(neutrophil-to-lymphocyte ratio,NLR)、淋巴细胞/单核细胞比率(lymphocyte-to-monocyte ratio,LMR)、血小板/淋巴细胞比率(platelet-to-lymphocyte ratio,PLR)、系统免疫炎症指数(systemic immune-inflammation index,SII)、系统性炎症评分(systemic inflammation score,SIS)及预后营养指数(prognostic nutritional index,PNI)与TSCC患者术后总生存期(overall survival,OS)和疾病特异性生存期(disease-specific survival,DSS)的相关性。使用X-tile软件确定连续变量的最佳截断值作为分界点。采用Kaplan-Meier生存分析和多变量Cox回归模型分析影响TSCC患者的独立预后预测因素,据此构建OS和DSS的生存相关列线图预测模型,通过训练集和验证集进行模型内部交叉验证和外部验证,具体通过一致性指数、时间依赖性受试者工作特征(receiver operating characteristic,ROC)曲线、曲线下面积(area under the curve,AUC)、校准曲线和决策曲线分析对列线图的准确性进行验证。结果:单因素Cox回归分析显示,TNM分期、T分期、N分期、分化程度、侵袭深度(depth of invasion,DOI)、肿瘤直径和治疗前PNI水平为影响TSCC预后危险因素;多因素Cox回归分析显示,治疗前PNI水平、N分期、DOI和肿瘤直径为患者5年OS或DSS的独立预后因素(P<0.05)。治疗前N分期≥1、PNI≤50.65和DOI>2.4 cm与较差的5年OS显著相关,而N分期≥1、PNI≤50.65、肿瘤直径>3.4 cm与较差的5年DSS显著相关。基于独立预后因素构建的Objective:To evaluate the prognostic significance of inflammatory biomarkers,prognostic nutritional index and clinicopathological characteristics in tongue squamous cell carcinoma(TSCC)patients who underwent cervical dissection.Methods:The retrospective cohort study consisted of 297 patients undergoing tumor resection for TSCC between January 2017 and July 2018.The study population was divided into the training set and validation set by 7∶3 randomly.The peripheral blood indices of interest were preoperative neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),platelet-to-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),systemic inflammation score(SIS)and prognostic nutritional index(PNI).Kaplan-Meier survival analysis and multivariable Cox regression analysis were used to evaluate independent prognostic factors for overall survival(OS)and disease-specific survival(DSS).The nomogram’s accuracy was internally validated using concordance index,receiver operating characteristic(ROC)curve,area under the curve(AUC),calibration plot and decision curve analysis.Results:According to the univariate Cox regression analysis,clinical TNM stage,clinical T category,clinical N category,differentiation grade,depth of invasion(DOI),tumor size and pre-treatment PNI were the prognostic factors of TSCC.Multivariate Cox regression analysis revealed that pre-treatment PNI,clinical N category,DOI and tumor size were independent prognostic factors for OS or DSS(P<0.05).Positive neck nodal status(N≥1),PNI≤50.65 and DOI>2.4 cm were associated with the poorer 5-year OS,while a positive neck nodal status(N≥1),PNI≤50.65 and tumor size>3.4 cm were associated with poorer 5-year DSS.The concordance index of the nomograms based on independent prognostic factors was 0.708(95%CI,0.625-0.791)for OS and 0.717(95%CI,0.600-0.834)for DSS.The C-indexes for external validation of OS and DSS were 0.659(95%CI,0.550-0.767)and 0.780(95%CI,0.669-0.890),respectively.The 1-,3-and 5-year time-dependent ROC analyses(AUC=0.

关 键 词：舌鳞状细胞癌 预后营养指数 预后预测模型 总生存期 疾病特异性生存期 列线图 

分 类 号：R739.8[医药卫生—肿瘤]