预测老年结肠癌患者根治术后生存情况的列线图模型的构建以及验证
Construction and Validation of a Nomogram Model for Predicting the Survival of Elderly Colon Cancer Patients after Radical Surgery
丁志翔 1于鹏 1刘郁1
作者信息
- 1. 新疆医科大学附属中医医院普外一科,乌鲁木齐 830000
- 折叠
摘要
目的 构建预测老年结肠癌患者根治术后生存情况的列线图模型,并验证此模型的预测价值.方法 选取2015 年1 月—2017 年12 月在新疆医科大学附属中医医院行根治性手术治疗的118 例老年结肠癌患者作为研究对象.对老年结直肠癌患者根治术后预后相关指标进行单因素 Cox 回归分析,将单因素分析中P<0.05的指标代入Cox 回归模型进行多因素分析,独立预测指标结合其影响权重构建预测老年结肠癌患者术后无进展生存率和总生存率的列线图模型并应用 R 软件绘制列线图,以 Bootstrap 法将样本进行重组并重复 1000次进行列线图模型的内部验证,计算区分度评价指标 C 指数(C-index),并通过拟合优度检验评价预测模型的准确度和预测效能.结果 单因素Cox 回归分析显示,分化程度、TNM/T 分期、淋巴结转移、Ki-67 及血管内皮生长因子(VEGF)均可能与老年结肠癌患者术后肿瘤无进展生存和总生存有关(P<0.05);多因素 Cox 回归分析显示,分化程度、TNM/T分期、淋巴结转移及VEGF均是老年结肠癌患者术后无进展生存和总生存的独立危险因素(P<0.05);应用 R 软件绘制列线图的区分度评价指标 C-index 分别为 0.843(95%CI:0.814～0.894)和0.838(95%CI:0.804～0.912),拟合优度检验显示,每个研究对象术后无进展生存率和总生存率的预测值与实际观测值符合度良好(P>0.05).结论 结合分化程度、TNM/T 分期、淋巴结转移及 VEGF 构建的列线图模型可准确预测老年结肠癌患者术后无进展生存和总生存.
Abstract
Objective To establish a nomogram model to predict the survival of elderly patients with colon cancer after radical resection,and to verify the predictive value of this model.Methods A total of 118 elderly patients with colon cancer who underwent radical surgery at the Xinjiang Medical University Affiliated Traditional Chinese Medicine Hospital from January 2015 to December 2017 were selected as the research subjects.The prognostic indicators of elderly patients with colorectal cancer after radical surgery were ana-lyzed by univariate Cox regression analysis.The meaningful indicators with P<0.05 in univariate analysis were substituted into the Cox regression model for multivariate analysis,independent predictors combined with their influence weight were used to build a nomogram model to predict the postoperative disease-free survival and overall survival of elderly colon cancer patients,and the nomogram was drawn with R software.The samples were reorganized by Bootstrap method and repeated 1000 times for internal verification of the nomogram model.The discrimination evaluation index C-index was calculated,and the accuracy and prediction efficiency of the prediction model were evaluated by goodness of fit test.Results Single factor Cox regression analysis showed that differentiation degree,TNM/T staging,lymph node metastasis,Ki-67,and VEGF might be associated with postoperative disease-free survival and overall survival in elderly colon cancer patients(P<0.05);Multivariate Cox regression analysis showed that differentiation degree,TNM/T staging,lymph node metas-tasis and VEGF were all independent risk factors of postoperative disease-free survival and overall survival in elderly colon cancer patients(P<0.05),The nomogram was drawn with R software.The discrimination evaluation C-indexe of the nomogram model were 0.843(95%CI:0.814-0.894)and 0.838(95%CI:0.804-0.912),respectively.The results of goodness of fit test showed that the pre-dicted values of postoperative disease-free survival and overall survival of each subject were in good agreement with the actual observed values(P>0.05).Conclusion The nomogram model combined with differentiation degree,TNM/T staging,lymph node metastasis and VEGF can accurately predict postoperative disease-free survival and overall survival of elderly patients with colon cancer.
关键词
血管内皮生长因子/结肠癌/列线图模型Key words
Vascular endothelial growth factor/Colon cancer/Nomogram model引用本文复制引用
基金项目
新疆维吾尔自治区自然科学基金项目(2021D01C235)
出版年
2024
国家科技期刊平台
NSTL
万方数据