宫颈癌同步放化疗预后及影响因素Cox回归预测模型构建
Construction of Cox regression prediction model for prognosis and its influencing factors in cervical cancer after concurrent chemoradiotherapy
倪鸣 1杨弋弋 1周新欢 1叶永生 1李松1
作者信息
- 1. 南阳市中心医院妇科,河南南阳 473000
- 折叠
摘要
目的 探讨宫颈癌同步放化疗预后及影响因素,并构建Cox回归预测模型.方法 纳入2018年7月至2021年9月在南阳市中心医院收治106例Ⅱa～Ⅳ期宫颈癌患者为此次研究对象,均采用容积旋转调强放疗+铂类两药方案同步化疗,随访至2023年11月或死亡时截止.分析患者生存情况、影响预后的相关因素,并构建预后预测模型.结果 对106例宫颈癌患者随访26～64个月,中位随访时间为45个月.死亡患者共40例,患者总生存率为62.26％.宫颈癌同步放化疗后总生存率与病理类型、分化程度、治疗前血红蛋白水平、完成放疗时间和临床分期有关(P＜0.05).Cox多因素风险模型分析显示,病理类型为腺癌(HR=2.373,P=0.039)、低分化程度(HR=2.259,P=0.044)、治疗前血红蛋白水平＜110 g/L(HR=2.143,P=0.030)、完成放疗时间＞9周(HR=2.052,P=0.029)和临床分期Ⅳa期(HR=2.026,P=0.041)均为影响宫颈癌同步放化疗预后死亡的独立风险因素(P＜0.05).根据多因素Cox比例风险回归模型分析结果,得到风险预测模型预后指数(PI)=2.373X1+2.259X2+2.143X3+2.052X4+2.026X5.X1、X2、X3、X4 和 X5 分别为病理类型、分化程度、治疗前血红蛋白水平、完成放疗时间和临床分期.Hosmer-Lemeshow x2=6.235,P=0.621.ROC分析显示,Cox比例风险回归模型预测宫颈癌同步放化疗预后的AUC为0.859,95％CI为0.787～0.931.结论 宫颈癌同步放化疗患者总生存率与病理类型、分化程度、治疗前血红蛋白水平、完成放疗时间和临床分期有关.
Abstract
Objective To explore the prognosis and its influencing factors in cervical cancer after concurrent chemoradio-therapy,and to construct Cox regression prediction model.Methods A total of 106 patients with stage Ⅱa-Ⅳ cervical cancer admitted to Nanyang Central Hospitall were enrolled as the research objects between July 2018 and September 2021,and all were treated with volumetric modulated arc therapy and platinum chemotherapy.The patients were fol-lowed up till November 2023 or death.The survival of patients and influencing factors of prognosis were analyzed.The prediction model for prognosis was constructed.Results In the 106 patients with cervical cancer with 26-64 months of follow-up,median follow-up time was 45 months.There were 40 death cases,and overall survival rate was 62.26％.After concurrent chemoradiotherapy,overall survival rate was related to pathological type,differentiation degree,hemo-globin level before treatment,radiotherapy time and clinical staging(P＜0.05).Cox multivariate risk model analysis showed that adenocarcinoma(HR=2.373,P=0.039),low differentiation(HR=2.259,P=0.044),hemoglobin level before treatment＜110 g/L(HR=2.143,P=0.030),radiotherapy time＞9 weeks(HR=2.052,P=0.029)and clinical staging at stage Ⅳa(HR=2.026,P=0.041)were independent risk factors of prognosis(P＜0.05).The re-sults of multivariate Cox proportional risk regression model analysis showed that the prognostic index(PI)was as follow:2.373X1+2.259X2+2.143X3+2.052X4+2.026X5(X1:pathological type,X2:differentiation degree,X3:hemo-globin level before treatment,X4:radiotherapy time,X5:clinical staging).Hosmer-Lemeshow x2=6.235,P=0.621.ROC curves analysis showed that AUC and 95％CI of Cox proportional risk regression model for predicting prog-nosis of cervical cancer were 0.859 and 0.787-0.931,respectively.Conclusion The overall survival rate is related to pathological type,differentiation degree,hemoglobin level before treatment,radiotherapy time and clinical staging in pa-tients with cervical cancer after concurrent chemoradiotherapy.
关键词
宫颈癌/同步放化疗/预后/风险比例模型/总生存率Key words
Cervical cancer/Concurrent chemoradiotherapy/Prognosis/Risk proportional model/Overall survival rate引用本文复制引用
基金项目
河南省科技发展计划(182102311190)
出版年
2024
NETL
NSTL
万方数据