摘要
目的基于术前炎性标志物Nomogram建立Ⅰ~Ⅲ期胃癌患者术后的生存预测模型。方法收集2015年5月至2016年10月河南省肿瘤医院普外科收治的1035例胃癌患者的临床病理及生存随访资料,采用COX回归方法建立Nomogram模型。采用受试者工作特征曲线(ROC)、一致性指数(C-index)、校准曲线以及临床决策曲线(DCA)验证该模型的性能。结果本组1035例患者中中性粒细胞与淋巴细胞比值(NLR)170例升高,865例降低;血小板与淋巴细胞比值(PLR)562例升高,473例降低;纤维蛋白原与白蛋白比值(FAR)108例升高,927例降低;预后营养指数(PNI)180例升高,855例降低;TNM分期Ⅰ期267例,Ⅱ期334例,Ⅲ期434例。多因素回归分析显示:肿瘤部位、有无脉管癌栓、pTNM分期、FAR、PNI及NLR是影响患者总生存期(OS)的独立危险因素。ROC曲线显示该Nomogram模型的3年和5年AUC分别为0.773和0.846;C-index为0.723(95%CI:0.710~0.736),优于AJCC第8版pTNM分期0.693(95%CI:0.681~0.705),校准曲线显示其3年和5年OS与实际观测结果有较好的一致性;DCA决策曲线结果显示,与第8版pTNM分期系统相比,在预测患者的3年和5年OS方面拥有更高的净收益。结论本研究建立并验证了针对Ⅰ~Ⅲ期胃癌患者术后的预后预测系统,以可视化的Nomogram模型预测患者的3年和5年OS,具有良好的预测性能和临床应用价值。
Objective To establish a nomogram to predict overall survival of patients with stageⅠ-Ⅲgastric cancer(GC)based on preoperative inflammatory markers.Methods Clinicopathological and follow-up data of 1035 patients with stageⅠ-Ⅲgastric cancer operated at He'nan Cancer Hospital between May 2015 and Oct 2016 were retrospectively collected.A nomogram was established based on prognostic factors.Harrell's concordance index(C-index),receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA)were used to verify the performance of the model according to differentiation,calibration and clinical utility.Results A total of 1035 patients were enrolled.The median follow-up time was 41.9 months;According to the optimal cutoff value,170 were with elevated neutrophil-to-lymphocyte ratio(NLR)and 865 with a reduced ratio;562 in elevated platelet-to-lymphocyte ratio(PLR)vs.473 in the reduced group;fibrinogen/albumin ratio(FAR)elevated in 108 group vs.972 in the reduced group;180 in the prognostic nutritional index score(PNI)elevated group and 855 in the reduced group.Two hundred and sixty-seven patients were categorized at stageⅠ,334 at stageⅡ,434 at stageⅢ.Multivariate regression analysis showed tumor location,vascular tumor thrombus,pTNM stage,FAR,PNI and NLR were independent prognostic factors(all P<0.05).The C-index of the nomogram was 0.723(95%CI:0.710-0.736)and had better clinical utility than the American Joint Committee on Cancer(AJCC)8th TNM staging system 0.693(95%CI,0.681-0.705).The calibration curve of the nomogram showed that the predicted survival rate was consistent with the actual survival rate in GC patients.Compared to AJCC 8th pTNM staging system,the DCA curve indicate that the nomogram has a higher net income.Conclusion The nomogram predicting overall survival of patients with stageⅠ-Ⅲgastric cancer is established and verified,which provides better individual prediction than TNM staging system.
作者
华科雷
霍明科
董志闯
李森
张贺
任莹坤
Hua Kelei;Huo Mingke;Dong Zhichuang;Li Sen;Zhang He;Ren Yingkun(Department of General Surgery,He'nan Cancer Hospital,Zhengzhou University,Zhengzhou 450008,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2022年第10期749-754,共6页
Chinese Journal of General Surgery
基金
河南省医学科技攻关计划联合共建项目(LHGJ20210174)。
关键词
胃肿瘤
预后
预测
列线图模型
Stomach neoplasms
Prognosis
Forcasting
Nomogram
