胸段食管鳞癌单纯根治术后总生存预测模型构建  

Nomogram to Predict Overall Survival for Thoracic Esophageal Squamous Cell Carcinoma with Radical Surgery Alone

作　　者：张欢 杨明威[1] 康梅[1] 朱礼阳 汪义纯[1] ZHANG Huan;YANG Mingwei;KANG Mei;ZHU Liyang;WANG Yichun(Department of Radiation Oncology,First Affiliated Hospital of Anhui Medical University,Hefei,China,230022)

机构地区：[1]安徽医科大学第一附属医院肿瘤放疗科,安徽合肥230032

出　　处：《食管疾病》2024年第2期95-101,共7页Journal of Esophageal Diseases

基　　金：安徽省高校自然基金重点项目(KJ2021A0300)。

摘　　要：目的构建并验证胸段食管鳞癌单纯根治术后总生存(overall survival,OS)的预测模型并分析术后复发特征以筛选高危人群,指导合理的辅助治疗。方法收集安徽医科大学第一附属医院2010年1月至2017年6月行单纯根治性手术的pT1-4aN0-3M0胸段食管鳞癌患者数据(训练组)及SEER(surveillance,epidemiology,and end results)数据库中2004年至2015年的数据(验证组)。采用Cox回归分析筛选训练组中影响OS的独立因素构建列线图预测模型,并在验证组中进行验证。利用受试者工作特征曲线下面积(area under the curve,AUC)及校正曲线评估列线图预测模型的准确性。结果最终纳入706例(训练组420例,验证组286例)患者进行分析。Cox回归分析显示训练组中病理T分期、N分期、性别及病变长度是影响OS的独立预后因素。利用上述因素构建的列线图预测训练组及验证组5 a的OS率的AUC值分别为0.711及0.740,好于第8版AJCC TNM分期系统且具有更好的危险分层;校正曲线显示两组数据中列线图模型预测OS的结果与实际十分吻合。结论本研究构建并验证了胸段食管鳞癌单纯根治术后预测OS的列线图模型,具有非常好的危险分层及预测价值。Objective We aimed to develop and validate a nomogram to predict the overall survival(OS)in TESCCs with radical surgery alone for screening the high-risk populations and guiding their reasonable adjuvant therapies.Methods TESCCs with pathological pT1-4aN0-3M0 undergoing radical surgery without perioperative therapies from Jan 2010 to June 2017 in our hospital were enrolled in the training cohort and TESCCs in the Surveillance,Epidemiology,and End Results(SEER)(2004-2015)dataset were enrolled in the validation cohort.The nomogram was developed using independent prognosis for OS analyzed by the Cox proportional hazard regression in the training cohort and subjected to the validation cohort.The predictive accuracy and discriminative ability of the nomogram was evaluated by the area under the curve(AUC)of the receiver operating characteristic curves,calibration curves.Results A total number of 706 patients(420 patients in the training cohort and 286 patients in the validation cohort)were enrolled in this study.The Cox regression analysis indicated that the pathological T stage,N stage,gender and tumor length were independent prognosis for OS.The nomogram constructed by these variables showed that the AUC for predicting 5-year OS in the training and validation cohorts were 0.711 and 0.740 respectively,which were higher than that of the 8th AJCC TNM stage systems.Calibration curves indicated good consistency between the nomogram prediction and actual observation for OS.Risk group stratification based on the nomogram scores allowed better distinction between survival curves than 8th AJCC TNM stage systems.Conclusion We have successfully established a novel nomogram with good risk stratification and discriminative ability for predicting OS in TESCCs with radical surgery alone.

关 键 词：食管肿瘤 预后 NOMOGRAM SEER 总生存 

分 类 号：R735.1[医药卫生—肿瘤]