基于SEER数据库胃印戒细胞癌病人预后列线图构建、验证与评价  

Development,validation and evaluation of prognostic nomogram to predict overall survival in patients with gastric signet ring cell carcinoma based on the SEER database

作　　者：董海峰 李康宁 张恒[1] 郑英斌[1] DONG Haifeng;LI Kangning;ZHANG Heng;ZHENG Yingbin(Department of General Surgery,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou,He'nan 450003,China)

机构地区：[1]郑州大学第二附属医院普通外科,河南郑州450003

出　　处：《安徽医药》2025年第3期529-535,共7页Anhui Medical and Pharmaceutical Journal

基　　金：河南省医学科技攻关联合共建项目基金(LHGJ20220456)。

摘　　要：目的分析影响胃印戒细胞癌(GSRC)病人的预后因素,构建并验证列线图以预测GSRC病人总生存率(OS)。方法收集监测、流行病学和最终结果(SEER)数据库中2010—2015年诊断为GSRC的病人1735例,根据R软件caret包按7∶3随机分为训练集(1251例)和验证集(484例)。采用LASSO-Cox回归筛选变量并构建列线图,验证和评价列线图模型的预测效能,并与第7版美国癌症联合委员会(AJCC)分期系统相比较。结果病人年龄、种族、T分期、N分期、M分期、婚姻状态、手术治疗、化疗、区域淋巴结数和肿瘤长径是GSRC病人预后的独立危险因素(P<0.05)。列线图一致性指数(C-index)在训练集和验证集中分别为0.78[95%CI:(0.76,0.79)]和0.76[95%CI:(0.74,0.79)]。1、3、5年OS受试者操作特征曲线(ROC曲线)下面积在训练集和验证集中分别是0.83、0.88、0.89和0.82、0.86、0.88。AJCC分期C-index在训练集和验证集中分别为0.70[95%CI:(0.68,0.71)]和0.67[95%CI:(0.64,0.70)]。1、3、5年OS ROC曲线下面积在训练集和验证集中分别为0.72、0.80、0.82和0.69、0.76、0.79。结论列线图能够对GSRC病人的总生存率做出个体化预测,为临床决策提供依据。Objective To assess the prognostic factors of gastric signet ring cell carcinoma(GSRC)patients,and to construct and validate a nomogram to predict the overall survival rate(OS)of GSRC patients.Methods Data of 1735 patients diagnosed with GSRC from 2010 to 2015 were collected from the Surveillance,Epidemiology,and End Results(SEER)database and randomly divided into a training set(n=1251)and a validation set(n=484)according to the R software caret package in a 7:3 ratio.LASSO Cox regression was used to screen variables and construct a column chart to validate and evaluate the predictive performance of the column chart model,and compared with the 7th edition of the American Joint Committee on Cancer(AJCC)staging system.Results Age,marital status,race,T stage,N stage,M stage,surgical treatment,chemotherapy,regional lymph nodes examined,and tumor size were identified as independent risk factors for the prognosis of GSRC patients.The C-index of the nomogram was observed to be 0.78[95%CI:(0.76,0.79)]in the training set and 0.76[95%CI:(0.74,0.79)]in the validation set.Additionally,the areas under the curve(AUC)of the 1-,3-,and 5-year OS receiver operating characteristic curves(ROC)in the training set were found to be 0.83,0.88,and 0.89,respectively,with the corresponding figures in the validation set being 0.82,0.86,and 0.88.The AJCC staging C-index was 0.70[95%CI:(0.68,0.71)]and 0.67[95%CI:(0.64,0.70)]in the training and validation sets,respectively.The areas under the ROC curve of the 1-,3-,and 5-year OS were 0.72,0.80,0.82 and 0.69,0.76,0.79 in the training and validation sets,respectively.Conclusion The nomogram can be utilized to evaluate the OS of GSRC patients on an individual basis,providing a useful tool for clinical decision-making.

关 键 词：癌 印戒细胞 病理状态 体征和症状 LASSO-Cox回归 列线图 监测、流行病学和最终结果数据库 预后 

分 类 号：R73[医药卫生—肿瘤]