Ⅳ期非小细胞肺癌患者的生存分析及列线图预测模型的构建:一项回顾性队列研究  

Survival Analysis of Patients with Stage IV Non-Small Cell Lung Cancer and Construction of Nomogram Prediction Model:A Retrospective Cohort Study

作　　者：封佳莉 周蕾[1] 赵天成[2] 徐蔚杰[1] 杨昕 沈倩芸 李和根[1] FENG Jiali;ZHOU Lei;ZHAO Tiancheng;XU Weijie;YANG Xin;SHEN Qianyun;LI Hegen(Third Department of Oncology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Department of Thoracic Surgery,Sixth Affiliated Hospital of Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海中医药大学附属龙华医院肿瘤三科,上海200032 [2]上海交通大学医学院附属第六人民医院胸外科,上海200233

出　　处：《中医肿瘤学杂志》2024年第6期51-59,共9页Journal of Oncology in Chinese Medicine

基　　金：国家自科学基金资助项目(编号:82374532);国家中医药管理局高水平中医药重点学科建设项目(中医肿瘤病学)(编号:zyyzdxk-2023063);上海市名老中医学术经验研究工作室建设项目(编号:SHGZS-202215);上海市中医肿瘤临床医学研究中心项目(编号:21MC1930500);浦东新区卫生健康委员会卫生计生科研项目(编号:PW2019E-1)。

摘　　要：目的基于回顾性队列研究评价中医药治疗不同暴露程度对Ⅳ期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的生存期影响,并构建预测模型。方法收集上海中医药大学附属龙华医院肿瘤三科接受中医药治疗的700例Ⅳ期非小细胞肺癌患者的临床资料,根据平均每年接受中医药治疗时间进行分组,评估比较三组队列基线分布的均衡性及中位生存期(median survival time,MST)情况,采用Kaplan-Meier法和Cox回归模型对700例晚期NSCLC患者生存期的影响因素进行单因素分析和多因素分析,建立Cox比例风险模型及列线图预测模型。结果①队列分析显示,中医药治疗可改善Ⅳ期NSCLC患者的生存期,高暴露组MST为37.0个月,中暴露组MST为25.0个月,低暴露组MST为18.4个月。②单因素分析结果显示,患者的性别、确诊时的体力状态(performance status,PS)评分、年龄、病理类型及临床分期、吸烟史、既往手术史、靶向治疗、口服中成药、中药静脉制剂疗程是Ⅳ期NSCLC患者的预后影响因素(P<0.05)。③Cox多因素分析结果显示:性别、PS评分、临床分期、病理类型是Ⅳ期NSCLC患者预后的独立危险因素,既往手术史、靶向治疗、中药静脉制剂是Ⅳ期NSCLC患者预后的独立保护因素。④基于多因素分析结果建立的列线图模型预测Ⅳ期NSCLC患者一年、三年、五年生存概率的ROC曲线AUC值为0.796、0.762、0.765,ROC曲线及校准曲线均表明预后模型与实际观测结果拟合性较好。结论中医药治疗时间平均每年大于6个月可延长Ⅳ期NSCLC患者的生存期。基于性别、年龄、PS评分、临床分期、病理类型、既往手术史、靶向治疗和以中医药治疗为暴露因素的队列分组而构建的Ⅳ期NSCLC患者的列线图模型具有良好的预测能力及精准度。Objective A retrospective cohort study was conducted to evaluate the effect of different exposure levels of traditional Chinese medicine(TCM)on the survival of patients with stage IV non-small cell lung cancer(NSCLC)and to establish a predictive model.Methods The clinical data of 700 patients with stage IV NSCLC who received TCM treatment in the Third Department of Oncology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine was collected.The patients were divided into three groups according to the average annual time of TCM treatment.The balance of baseline distribution and median survival time(MST)among the three groups were evaluated and compared.Kaplan-Meier method and Cox regression model were used to conduct univariate and multivariate analysis on the influencing factors of survival of 700 patients with advanced NSCLC.Cox proportional hazard model and nomogram prediction model were established.Results①Cohort analysis showed that the survival time of stage IV NSCLC patients was significantly improved by TCM treatment.The MST of high exposure group was 37.0 months,the middle exposure group was 25.0 months,and the low exposure group was 18.4 months.②The results of univariate analysis showed that gender,performance status(PS)score at the time of diagnosis,age,pathological type,clinical stage,smoking history,previous surgical history,targeted therapy,oral Chinese patent medicine,and Chinese medicine intravenous preparation treatment were prognostic factors for stage IV NSCLC patients(P<0.05).③The Cox multivariate results showed that gender,PS score,clinical stage,and pathological type were independent risk factors for the prognosis of stage IV NSCLC patients.Previous surgical history,targeted therapy,and intravenous preparation of TCM were independent protective factors for prognosis of stage IV NSCLC patients.④The AUC values of ROC curves for predicting the 1-year,3-year,and 5-year survival probability of stage IV NSCLC patients using the nomogram model based on the result

关 键 词：非小细胞肺癌 队列研究 中医药疗法 列线图 预后模型 

分 类 号：R273[医药卫生—中西医结合] R734.2[医药卫生—中医肿瘤科]