颅内生殖细胞肿瘤患者的预后模型:一项基于SEER数据库的研究  

A prognostic model for patients with intracranial germ cell tumors:a SEER population-based study

作　　者：杨守博 于建宇 王灿 康勋 陈峰[1] 李文斌 Yang Shoubo;Yu Jianyu;Wang Can;Kang Xun;Chen Feng;Li Wenbin(Department of Neuro-oncology,Cancer Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院、肿瘤综合治疗中心、神经肿瘤综合治疗病区,100070

出　　处：《神经疾病与精神卫生》2024年第10期727-734,共8页Journal of Neuroscience and Mental Health

基　　金：国家自然科学基金项目(81972338)。

摘　　要：目的采用监测、流行病学和最终结果(SEER)数据库构建颅内生殖细胞肿瘤(iGCT)总生存期的预后模型,预测患者预后并指导治疗。方法收集SEER数据库1975—2020年1105例iGCT患者的临床病理学和社会人口学资料。通过1∶1比例将患者随机分为训练集和验证集,采用单变量和多变量Cox回归模型筛选独立预后因素,构建预后评分表预测iGCT患者的总生存期。通过受试者工作特征曲线下面积(AUC)、一致性指数(C-index)、校准曲线和决策曲线分析(DCA)指标来评估预后评分表的性能。结果所有iGCT患者的中位随访时间为84个月,其中成年患者为79个月,儿童患者为87个月。原发部位(HR=0.616,95%CI=0.451~0.843,P=0.002)、放疗(HR=0.390,95%CI=0.286~0.533,P<0.001)、化疗(HR=0.656,95%CI=0.475~0.905,P=0.01)和年龄(HR=0.658,95%CI=0.479~0.905,P=0.01)是总生存期的独立预后因素。利用这些临床因素构建预测总生存期的预后评分表,该模型在训练集1年、5年、10年生存率的AUC分别为0.751、0.658、0.644,C-index分别为0.739、0.645、0.649,在验证集1年、5年、10年生存率的AUC分别为0.862、0.752、0.734,C-index分别为0.850、0.716、0.720,校准曲线与标准参考曲线重合度较好,DCA提示模型训练集风险概率为0.125~0.25时净收益较高,验证集风险概率为0.25~0.375时净收益较高,该模型与全变量预测模型曲线重合度较好。结论iGCT患者的原发部位、治疗方法、年龄组与预后相关,据此构建的预后评分表有助于预测患者预后并指导治疗。Objective To construct a prognostic model for the overall survival of intracranial germ cell tumors(iGCT)based on the Surveillance,Epidemiology,and End Results(SEER)database,so as to predict prognosis and guide treatment.Methods Clinical pathological and sociodemographic data of 1105 iGCT patients from 1975 to 2020 were collected from the SEER database.The patients were randomly divided into a training set and a validation set in a 1∶1 ratio.Univariate and multivariate Cox regression were used to screen for independent prognostic factors and construct the Outcome Scale to predict the overall survival of iGCT patients.The area under the receiver operating characteristic curve(AUC),consistency index(C-index),calibration curve,and decision curve analysis(DCA)indicators were used to evaluate the performance of the Outcome Scale.Results The median follow-up time for all iGCT patients was 84 months,including 79 months for adult patients and 87 months for pediatric patients.Primary site[HR=0.616,95%CI(0.451,0.843),P=0.002],radiotherapy[HR=0.390,95%CI(0.286,0.533),P<0.001],chemotherapy[HR=0.656,95%CI(0.475,0.905),P=0.01],and age[HR=0.658,95%CI(0.479,0.905),P=0.01]were independent prognostic factors for overall survival,with statistically significant differences.The Outcome Scale for predicting overall survival constructed using these clinical factors showed that the AUC of the 1-year,5-year,and 10-year survival rates in the training set were 0.751,0.658,and 0.644,respectively,and the C-indices were 0.739,0.645,and 0.649,respectively.The AUC of the 1-year,5-year,and 10-year survival rates in the validation set were 0.862,0.752,and 0.734,respectively,and the C-indices were 0.850,0.716,and 0.720,respectively.The calibration curve had a good overlap with the standard reference curve.DCA suggested that the training set of the model had a high net return between risk probabilities of 0.125 and 0.25,while the validation set has a high net return between risk probabilities of 0.25 and 0.375.The model had a good overlap with th

关 键 词：预后评分表 颅内生殖细胞肿瘤 总生存期 预后模型 

分 类 号：R739.41[医药卫生—肿瘤]