淋巴结阳性比率对评估胃印戒细胞癌患者预后价值的分析  

Analysis of the lymph node positive rate for assessing the prognostic value of patients with gastric signet-ring cell carcinoma

作　　者：林铭华 兰禄英 叶文 LIN Ming-hua;LAN Lu-ying;YE Wen(Department of Gastroenterology,Longyan First Hospital Affiliated to Fujian Medical University,Fujian 364000,China;不详)

机构地区：[1]福建医科大学附属龙岩第一医院消化内科,福建364000 [2]福建省龙岩市第二医院医务处 [3]福建医科大学附属龙岩第一医院胃肠外科

出　　处：《慢性病学杂志》2024年第10期1441-1450,共10页Chronic Pathematology Journal

基　　金：龙岩市科技计划项目(2023LYF17028)

摘　　要：目的探究淋巴结阳性比率(lymph node positive rate,LNR)对评估胃印戒细胞癌(gastric signet-ring cell carcinoma,CSRCC)患者预后的价值,并探讨包含该比率的预测模型对患者总体生存率(overall survival,OS)的预测价值。方法筛选美国国立癌症研究所数据库(the surveillance epidemiology and end results,SEER)2010年1月—2015年12月的数据,选取符合纳入与排除标准的1659例CSRCC患者为研究对象,并按照7∶3的比例随机选取训练集和验证集。利用X-tile软件确定LNR的最佳截断点,利用Cox回归分析选取独立影响CSRCC患者预后的因子并构建预测模型。结果X-tile结果表明,当LNR为30%时,两组CSRCC患者间的生存差异最大。Cox回归分析表明,在CSRCC患者中,LNR、年龄、婚姻状态、收入、肿瘤分级、T分期和肿瘤大小都是预后的独立影响因子。在训练集中,包含LNR的列线图显示,1、3、5年生存率的受试者操作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)分别为0.778、0.839、0.778;在验证集中,1、3、5年生存率的AUC分别为0.767、0.838、0.837。此外,通过绘制校准曲线和决策曲线分析(decision curve analysis,DCA),验证了该模型的准确性和有效性。结论LNR对胃印戒细癌患者预后具有较高的预后价值。LNR>30%是CSRCC患者OS差异的独立危险因素,包含LNR的列线图对CSRCC患者预后的预测价值较高。Objective To explore the value of the lymph node positive rate(LNR)for the prognosis of patients with gastric signet-ring cell carcinoma(CSRCC)and to explore the predictive value of a prediction model including this ratio for overall survival(OS).Methods Data from the surveillance epidemiology and end results(SEER)from January 2010 to December 2015 were screened,and 1659 CSRCC patients who met the inclusion and exclusion criteria were selected as study subjects,and the training set and validation set were randomly selected at a ratio of 7∶3.The optimal cut-off point for LNR was determined using the X-tile software,and Cox regression analysis was used to select factors independently of the impact on the prognosis of CSRCC patients and construct the prediction model.Results X-tile analysis revealed that the maximum survival difference between the two groups of GSRCC patients was observed when the LNPR was 30%.Multivariate Cox regression analysis demonstrated that LNR,age,marital status,income,tumor grade,T stage,and tumor size were independent prognostic factors for OS in patients with GSRCC.The receiver operating characteristic(ROC)curves of the training set exhibited area under the curve(AUC)was 0.778,0.839,0.778 for 1-year,3-year,and 5-year survival rates,respectively,while the AUCs for the validation set were 0.767,0.838,0.837.In addition,calibration and decision curve analysis(DCA)confirmed the accuracy and clinical utility of the model.Conclusions The lymph node positive rate has considerable prognostic value for patients with gastric signet-ring cell carcinoma.The lymph node positive rate>30%is an independent risk factor for poor overall survival in patients with gastric signet-ring cell carcinoma patients,and a nomographic chart containing lymph node positive rate has a high predictive value for the prognosis of gastric signet-ring cell carcinoma patients.

关 键 词：胃印戒细胞癌 淋巴结阳性比率 预后 

分 类 号：R735.2[医药卫生—肿瘤]