首页|基于SEER数据库构建预测T2期胆囊癌患者癌症特异性生存时间的列线图模型

基于SEER数据库构建预测T2期胆囊癌患者癌症特异性生存时间的列线图模型

Development of a prognostic nomogram for predicting cancer-specific survival time of T2 stage gall-bladder cancer patients based on the SEER database

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目的 基于"监测,流行病学和最终结果"(SEER)数据库构建预测T2期胆囊癌患者癌症特异性生存时间(CSST)的列线图模型.方法 收集SEER数据库中2018年至2020年486例T2期胆囊癌患者的临床资料,其中男性147例,女性339例,年龄(70±13)岁.从SEER数据库中提取T2期胆囊癌患者诊断时的年龄、性别、肿瘤长径、肿瘤分期、手术方式、淋巴结清扫数量、术后治疗情况、预后等临床信息.Cox风险比例回归分析胆囊癌患者CSST的影响因素.基于多因素Cox回归分析所得的独立危险因素构建列线图,使用受试者工作特征(ROC)曲线下面积评估列线图模型的预测能力,同时使用校准图、决策曲线分析、临床影响曲线评价模型的可用性和实际效益.结果 多因素Cox回归分析结果表明,肿瘤长径≥30 mm(HR=1.775,95%CI:1.123~2.806)、美国癌症联合委员会(AJCC)分期 ⅢB(HR=6.083,95%CI:2.961~12.495)、切除 1~3 个淋巴结(HR=6.139,95%CI:2.876~13.106)、术后未行化疗(HR=1.743,95%CI:1.096~2.771)的 T2 期胆囊癌患者,CSST 短的风险高(均P<0.05).基于上述危险因素构建了预测CSST的列线图模型,该模型预测T2期胆囊癌患者1年、2年CSST的ROC曲线下面积分别为0.778和0.696.校准图显示预测概率和实际概率之间具有良好的一致性.决策曲线分析和临床影响曲线显示列线图模型具有较高的净收益和临床有效性.结论 肿瘤长径≥30 mm、AJCC分期ⅢB、切除1~3个淋巴结、术后未行化疗是T2期胆囊癌患者CSST短的危险因素,基于上述因素构建了列线图模型对T2期胆囊癌患者CSST的预测效能良好.
Objective Based on"the surveillance,epidemiology,and end results"(SEER)data-base,we constructed a nomogram model for predicting cancer-specific survival time(CSST)in patients with T2 stage gallbladder cancer.Methods Clinical data on 486 patients with T2 stage gallbladder cancer between 2018 and 2020 were retrospectively collected from the SEER database.The cohort comprised 147 male and 339 female patients with the age at diagnosis of(70±13)years.Clinical information including age,gender,tumor size,tumor stage,surgical type,number of lymph node dissection,postoperative treat-ment,and patients prognosis were extracted from the SEER database.We analyzed the factors influencing CSST in patients with T2 stage gallbladder cancer using Cox risk-proportional regression.The nomogram model was constructed based on independent risk factors obtained from multivariate Cox regression analysis,and the area under curve(AUC)of receiver operating characteristic curves(ROC)were used to evaluate the predictive accuracy of the nomogram model,while calibration plots,decision curve analysis,and clinical impact curves were used to evaluate the model's practicality and effectiveness.Results The results of multi-variate Cox regression analysis showed that patients with tumor size≥30 mm(HR=1.775,95%CI:1.123-2.806),AJCC stage ⅢB(HR=6.083,95%CI:2.961-12.495),1-3 lymph node dissection(HR=6.139,95%CI:2.876-13.106),no postoperative chemotherapy(HR=1.743,95%CI:1.096-2.771)had a higher risk of short CSST(all P<0.05).A nomogram model for predicting CSST was con-structed based on the above risk factors,and the AUC of the ROC of which for predicting 1-year and 2-year CSST in patients with T2 stage gallbladder cancer was 0.778 and 0.696,respectively.Calibration plots demonstrated excellent collinearity between predicted and actual probabilities.Decision curve analysis and clinical impact curves confirmed high net benefit and clinical validity of the nomogram model.Conclusions The tumor size ≥30 mm,AJCC stage ⅢB,1-3 lymph node dissection and no postoperative chemotherapy are risk factors for short CSST in patients with T2 gallbladder cancer.The nomogram model based on the above risk factors have excellent performance in predicting CSST in patients with T2 stage gallbladder cancer.

Gallbladder neoplasmsSurgical treatmentLymph node dissectionChemothe-rapyPrognosis

高振宇、张军港、杜程飞、方正康、石英、黄浩、余子辰、张成武

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浙江省人民医院(杭州医学院附属人民医院)肝胆胰外科、微创外科,杭州 310014

浙江省人民医院(杭州医学院附属人民医院)产科,杭州 310014

胆囊肿瘤 手术治疗 淋巴结清扫 化疗 预后

2024

中华肝胆外科杂志
中华医学会

中华肝胆外科杂志

CSTPCD北大核心
影响因子:1.846
ISSN:1007-8118
年,卷(期):2024.30(12)