基于SEER数据库的育龄期女性Ⅰ期卵巢透明细胞癌不同治疗方式生存率分析和术后生存预测模型构建  

Selection of treatment and construction of postoperative prediction model for Stage I ovarian clear cell carcinoma in women of childbearing age

作　　者：张莎 王路路 刘楚琦 雷冬梅[2] 郭瑞霞[3] Zhang Sha;Wang Lulu;Liu Chuqi(Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450000)

机构地区：[1]郑州大学第三附属医院妇产科,郑州450000 [2]郑州大学第三附属医院病理科,郑州450000 [3]郑州大学第一附属医院妇科,郑州450000

出　　处：《现代妇产科进展》2024年第4期249-254,共6页Progress in Obstetrics and Gynecology

基　　金：国家自然科学基金(联合基金项目)(No:U2004117)

摘　　要：目的:探讨Ⅰ期卵巢透明细胞癌(OCCC)患者不同治疗方式之间的长期预后差异,构建列线图预测术后Ⅰ期OCCC患者的预后。方法:从SEER数据库中筛选2010年至2019年组织学诊断为OCCC的患者。使用Kaplan-Meier评估根治性手术与保留子宫手术联合或不联合化疗对OCCC患者总生存期(OS)和癌症特异性生存期(CSS)的影响。Cox比例风险模型评估临床病理因素与OS和CSS的相关性。使用与OS和CSS显著相关的参数构建列线图,通过内部验证评估列线图的性能。结果:共纳入824例OCCC患者,173例单独接受子宫切除术(HRT),430例子宫切除术后辅助化疗(HRT+CT),54例选择保留子宫的术式(NHRT),167例选择NHRT+CT。与其余三者相比,接受NHRT患者拥有最好的CSS和OS(P=0.0077,0.0078)。单独接受NHRT治疗的患者比接受NHRT+CT治疗的患者具有更好的生存率(CSS:P=0.0052;OS:P=0.0062)。多变量Cox回归分析表明,年龄、婚姻状态、肿瘤分期、治疗方案是CSS和OS的独立预后因素。根据结果建立了Ⅰ期OCCC患者术后预后列线图,CSS和OS列线图ROC曲线下面积(AUC)分别为0.7和0.701,列线图的DCA结果表明预测模型在临床上是有益的,标准曲线与实际观测值具有良好一致性。结论:保留生育功能的手术可能是育龄期Ⅰ期OCCC女性患者的替代治疗选择。关于是否辅助化疗,仍需进一步研究确定其在Ⅰ期OCCC患者中的作用。构建的列线图对Ⅰ期OCCC术后患者具有良好的生存预测和临床应用价值。Objective:To investigate the long-term prognosis of patients with stage I ovarian clear cell carcinoma(OCCC),and constructed a nomogram to predict the prognosis of patients with OCCC at stage I after surgery.Methods:Patients with a histological diagnosis of ovarian clear cell carcinoma between 2010 and 2019 were identified from the SEER database for the study.Kaplan-Meier were used to evaluate the effect of radical surgery with or without chemotherapy on overall survival and cancer-specific survival.Cox proportional risk models were used to assess the association of clinicopathological factors with overall survival(OS)and cancer-specific survival(CSS).Create a nomogram using parameters that were significantly relevant to OS and CSS,and evaluate the performance of the nomogram with internal validation.Result:A total of 824 patients with OCCC were included,and 173 patients received hysterectomy(HRT)alone,adjuvant chemotherapy after hysterectomy(HRT+CT)in 430 cases,54 patients underwent the operation of preserving uterus(NHRT).167 cases selected NHRT+CT.Patients receiving NHRTS had the best prognosis for CSS and OS compared to the other three(P=0.0077,0.0078).Patients treated with NHRT alone had better survival rates than those treated with NHRT+CT(CSS,P=0.0052;OS,P=0.0062).Multivariate Cox regression analysis confirmed that age,marital status,tumor stage and treatment plan were independent prognostic factors of CSS and OS.According to the results,the postoperative prognosis histogram of stage I OCCC patients was established,and the area AUC under the ROC curve of CSS and OS histogram was 0.7 and 0.701,respectively.The DCA results of the column graph showed that the prediction model was beneficial in clinic,and the standard curve was in good agreement with the observed values.Conclusions:Fertility-sparing surgery may be an alternative treatment option for women of childbearing age with stage I OCCC.Further research is needed to determine the role of adjuvant chemotherapy in patients with stage I OCCC.The constructed

关 键 词：卵巢透明细胞癌 SEER数据库 治疗方式 列线图 生存率 

分 类 号：R737.31[医药卫生—肿瘤]