头颈部腺样囊性癌预后影响因素分析及预后预测模型构建  

Analysis of prognostic influencing factors and construction of prognostic predictive models for head and neck adenoid cystic carcinoma

作　　者：王君洁 杨治花[1] 马小茶 张娟[2] 师卫华[2] 折虹[1] Wang Junjie;Yang Zhihua;Ma Xiaocha;Zhang Juan;Shi Weihua;Zhe Hong(Department of Radiotherapy,General Hospital of Ningxia Medical University,Yinchuan 750001,China;Department of Medical Oncology of the First People's Hospital of Yinchuan,Yinchuan 750001)

机构地区：[1]宁夏医科大学总医院放疗科,银川750001 [2]银川市第一人民医院肿瘤内科,银川750001

出　　处：《肿瘤研究与临床》2024年第4期248-254,共7页Cancer Research and Clinic

摘　　要：目的探讨头颈部腺样囊性癌(ACCHN)患者预后的影响因素,构建预测患者预后的列线图模型。方法回顾性病例系列研究。收集2013年1月至2019年12月宁夏医科大学总医院经病理检查确诊的70例ACCHN患者临床资料。采用Kaplan-Meier法进行生存分析,并行log-rank检验。采用Cox比例风险模型对预后影响因素进行单因素和多因素分析。基于多因素分析结果及其他相关临床因素,采用R 4.3.1软件Rms、Survival包构建预测ACCHN患者总生存(OS)、无进展生存(PFS)率的列线图模型;采用Bootstrap法进行300次重复抽样,对列线图的预测效能进行内部验证。模型的区分度用一致性指数、受试者工作特征(ROC)曲线及曲线下面积(AUC)进行评价;通过绘制校准曲线评估模型的校准度;采用临床决策曲线分析(DCA)评估列线图模型的临床获益和应用价值。结果70例ACCHN患者中,男性26例,女性44例;年龄[M(Q_(1),Q_(3))]52岁(45岁,62岁)。70例ACCHN患者3、5年OS率分别为89.1%、79.8%,3、5年PFS率分别为80.2%、64.2%。不同年龄、肿瘤原发部位ACCHN患者的5年OS率比较,差异均有统计学意义(均P<0.05)。不同肿瘤原发部位、Ki-67阳性指数及有无淋巴结转移ACCHN患者的5年PFS率比较,差异均有统计学意义(均P<0.05)。多因素Cox回归分析结果显示,年龄(HR=4.867,95%CI:1.341~17.666,P=0.016)、肿瘤原发部位(HR=10.725,95%CI:1.214~94.776,P=0.033)和Ki-67阳性指数(HR=8.637,95%CI:1.266~58.903,P=0.028)是ACCHN患者OS的独立影响因素;性别(HR=0.296,95%CI:0.105~0.840,P=0.022)、肿瘤原发部位(HR=7.185,95%CI:1.541~33.949,P=0.012)、有无淋巴结转移(HR=4.220,95%CI:1.233~14.444,P=0.022)和Ki-67阳性指数(HR=2.954,95%CI:1.084~8.049,P=0.034)是ACCHN患者PFS的独立影响因素。构建预测ACCHN患者OS、PFS的列线图模型,采用Bootstrap法重复抽样300次,一致性指数分别为0.815(95%CI:0.697~0.933)和0.843(95%CI:0.747~0.939);列线图模型预测3、5年OS率的AUC分�Objective To explore the factors influencing the prognosis of patients with adenoid cystic carcinoma of head and neck(ACCHN),and to establish nomogram models for predicting the prognosis of these patients.Methods A retrospective case series study was performed.The clinical data of 70 patients who were pathologically diagnosed with ACCHN in the General Hospital of Ningxia Medical University from January 2013 to December 2019 were collected.Kaplan-Meier method was used for survival analysis,and log-rank test was used to make comparison among groups.Cox proportional risk model was used to make univariate and multivariate analysis of the prognostic influencing factors.Based on the multivariate analysis and other related clinical factors,the Rms and Survival package of R 4.3.1 software was used to construct the nomogram models for predicting the overall survival(OS)and the progression-free survival(PFS)of ACCHN patients.Internal validation was performed by using Bootstrap method with 300 repeated samples with playback.The distinction degrees of the nomogram models were verified by using the consistency index,receiver operating characteristic(ROC)curves and the area under the curve(AUC).Calibration curves were drawn to evaluate the calibration of models.The clinical benefit and the application value of these nomogram models were evaluated by clinical decision curve analyses(DCA).Results Among 70 patients with ACCHN,26 cases were male and 44 cases were female;the age[M(Q1,Q3)]was 52 years(45 years,62 years).The 3-year and 5-year OS rates of 70 ACCHN patients were 89.1% and 79.8%,respectively,and the 3-year and 5-year PFS rates of these patients were 80.2% and 64.2%,respectively.There were statistically significant differences in the 5-year OS rate among ACCHN patients with different ages and primary tumor location(all P<0.05);and there were statistically significant differences in the 5-year PFS rate among ACCHN patients with different primary tumor location,Ki-67 positive indexs,and lymph node metastatic status(all P<0

关 键 词：头颈部肿瘤 癌 腺样囊性 预后 列线图 

分 类 号：R739.91[医药卫生—肿瘤]