摘要
目的 探讨影响肝细胞癌(HCC)肺转移患者预后的危险因素,并建立能够预测HCC肺转移患者生存期的预测模型.方法 从美国国立癌症研究所建立的监测、流行病学和最终结果(SEER)数据库中提取2010—2015年及2018—2020年间,诊断为HCC肺转移的患者资料数据,根据纳入和排除标准从中筛选入组病例.将筛选的病例按7∶3的比例分为训练集和验证集.对两组患者的基线资料进行x2检验.根据训练集数据建立多因素Cox回归模型,建立患者生存列线图、计算C-指数、绘制ROC曲线及校准曲线评估模型预测能力.并利用验证集数据进行模型的内部验证.结果 从SEER数据库中筛选出符合纳入标准的患者共1348例,其中训练集944例、验证集404例.两组患者危险因素比较差异均没有统计学意义(P均>0.05).多因素Cox回归分析显示,患者性别、手术史、化疗史及T分期均为影响HCC肺转移患者预后的独立危险因素.根据6项危险因素构建列线图,训练集的C-指数为0.71(95％CI为0.68～0.72),预测HCC肺转移患者1、3、5年生存期的ROC曲线下面积(AUC)分别为0.80、0.80、0.79.验证集的C-指数为0.72(95％CI为0.67～0.73),1、3、5年的AUC分别为0.80、0.80、0.79.结论 基于SEER数据库中HCC肺转移患者的临床特征及诊疗资料构建的预测模型,可以对患者的预后及生存情况进行评估和预测.该预测模型仍需在前瞻性研究中进一步验证和优化.
Abstract
Objective To investigate the risk factors affecting the prognosis of patients with hepatocellular carcinoma (HCC) lung metastases and to construct a predictive model capable of predicting the survival of patients with HCC lung metastases. Methods Data from the Surveillance,Epidemiology,and End Results (SEER) database established by the National Cancer Institute were extracted from the patient profile data of patients diagnosed with HCC lung metastasis during 2010—2015 and 2018—2020,from which the enrolled cases were screened according to the inclusion and exclusion criteria. The screened cases were divided into training and validation sets in a ratio of 7∶3. The x2 test was performed on the baseline data of the two groups of patients. A multifactorial Cox regression model was established based on the data in the training set,and the predictive ability of the model was assessed by establishing a column chart of patient survival,calculating the C-index,and plotting the ROC curve and calibration curve. And internal validation of the model was performed using validation set data. Results A total of 1348 patients meeting the inclusion criteria were screened from the SEER database,including 944 patients in the training set and 404 patients in the validation set. The differences in risk factors between the two groups of patients were not statistically significant (all P>0.05). Multifactorial Cox regression analysis showed that patient gender,history of surgery,history of chemotherapy and T stage were all independent risk factors affecting the prognosis of patients with HCC lung metastases. A column-line graph was constructed based on the six risk factors,and the C-index for the training set was 0.71 (95％CI 0.68～0.72),and the area under the ROC curve (AUC) for predicting the survival of patients with HCC lung metastases at 1,3,and 5 years was 0.80,0.80,and 0.79,respectively. The C-index for the validation set was 0.72 (95％CI 0.67～0.73),and the AUC at 1,3 and 5-year AUC were 0.80,0.80,and 0.79,respectively. Conclusions The prediction model constructed based on the clinical characteristics and diagnostic and treatment information of patients with HCC lung metastases in the SEER database can assess and predict the prognosis and survival of patients. The prediction model still needs to be further validated and optimized in prospective studies.
维普
万方数据