中国普外基础与临床杂志

中国普外基础与临床杂志

利用SEER数据库进行胃腺癌患者生存预后Nomogram图的构建

查看全文

目的 利用监测、流行病学和结果数据库(SEER 数据库)进行胃腺癌患者生存预后 Nomogram 图的构建,从而预测胃腺癌患者的总生存率。 方法 从 SEER 数据库中提取 2004~2014 年期间的胃腺癌患者共 3 272 例,随机划分为建模组和验证组。采用 Cox 比例风险回归模型分析建模组患者的预后影响因素,再构建 Nomogram 图。利用一致性指数(C-index)和校正曲线对 Nomogram 图进行内部(建模组数据)与外部验证(验证组数据),评估其预测价值。 结果 建模组的 Cox 比例风险回归模型结果表明:年龄、人种、肿瘤分化等级、组织学类型、美国癌症联合委员会(AJCC)分期及手术治疗均是胃腺癌患者的预后影响因素(P<0.05),均被用于构建 Nomogram 图。Nomogram 图的内部与外部验证结果表明,建模组的 C 指数为 0.751 [95%CI为(0.738,0.764)],验证组为 0.753 [95%CI为(0.734,0.772)];2 组的校正曲线均表现出良好的一致性。 结论 本研究构建的胃腺癌患者生存预后预测的 Nomogram 图具有良好的预测价值,可为临床医师提供了更为准确及实用的预测工具,利于个体化地对患者的生存预后作出快速准确的评估。

Objective Establishing Nomogram to predict the overall survival (OS) rate of patients with gastric adenocarcinoma by utilizing the database of the Surveillance, Epidemiology, and End Results (SEER) program. Methods Obtained the data of 3 272 gastric adenocarcinoma patients who were diagnosed between 2004 and 2014 from the SEER database. These patients were randomly divided into training (n=2 182) and validation (n=1 090) cohorts. The Cox proportional hazards regression model was performed to evaluate the prognostic effects of multiple clinicopathologic factors on overall survival. Significant prognostic factors were combined to build nomogram. The predictive performance of nomogram was evaluated via internal (training cohort data) and external validation (validation cohort data) by calculating index of concordance (C-index) and plotting calibration curves. Results In the training cohort, on Cox proportional hazards regression model analysis, age at diagnosis, race, grade, 6th American Joint Committee on Cancer (AJCC) stage, histologic type, and surgery were significantly associated with the survival prognosis (P<0.05). These factors were used to establish Nomogram. The Nomograms showed good accuracy in predicting OS rate, with C-index of 0.751 [95%CI was (0.738, 0.764)] in internal validation and C-index of 0.753 [(95% CI was (0.734, 0.772)] in external validation. All calibration curves showed excellent consistency between prediction by Nomogram and actual observation. Conclusion Novel Nomogram for patients with gastric adenocarcinoma was established to predict OS in our study has good prognostic significance, it can provide clinicians with more accurate and practical predictive tools which can quickly and accurately assess the patients’ survival prognosis individually, and can better guiding clinicians in the follow-up treatment of patients.

关键词: 胃腺癌; SEER数据库; 生存分析; Nomogram图

Key words: gastric adenocarcinoma; database of the Surveillance, Epidemiology, and End Results (SEER) program; survival analysis; Nomogram

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends-an update. Cancer Epidemiol Biomarkers Prev, 2016, 25(1): 16-27.
2. Ajani JA, Lee J, Sano T, et al. Gastric adenocarcinoma. Nat Rev Dis Primers, 2017, 3: 17036.
3. 李小宝, 梅乐园, 车向明. 影响胃癌预后因素的研究进展. 中国普通外科杂志, 2013, 22(4): 494-497.
4. 梁寒. 影响胃癌预后因素研究进展. 中国实用外科杂志, 2011, 31(8): 726-729.
5. Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180.
6. Liang W, Zhang L, Jiang G, et al. Development and validation of a nomogram for predicting survival in patients with resected non-small-cell lung cancer. J Clin Oncol, 2015, 33(8): 861-869.
7. Wang Y, Li J, Xia Y, et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol, 2013, 31(9): 1188-1195.
8. Wang ZX, Qiu MZ, Jiang YM, et al. Comparison of prognostic nomograms based on different nodal staging systems in patients with resected gastric cancer. J Cancer, 2017, 8(6): 950-958.
9. Cronin KA, Ries LA, Edwards BK. The Surveillance, Epidemiology, and end Results (SEER) program of the national cancer institute. Cancer, 2014, 120 Suppl 23: 3755-3757.
10. Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med, 1996, 15(4): 361-387.
11. Huitzil-Melendez FD, Capanu M, O'Reilly EM, et al. Advanced hepatocellular carcinoma: which staging systems best predict prognosis? J Clin Oncol, 2010, 28(17): 2889-2895.
12. Sternberg CN. Are nomograms better than currently available stage groupings for bladder cancer? J Clin Oncol, 2006, 24(24): 3819-3820.
13. Zhang Y, Zhang J, Zeng H, et al. Nomograms for predicting the overall and cancer-specific survival of patients with classical Hodgkin lymphoma: a SEER-based study. Oncotarget, 2017, 8(54): 92978-92988.
14. Liu J, Su M, Hong S, et al. Nomogram predicts survival benefit from preoperative radiotherapy for non-metastatic breast cancer: a SEER-based study. Oncotarget, 2017, 8(30): 49861-49868.
15. Zhang ZY, Luo QF, Yin XW, et al. Nomograms to predict survival after colorectal cancer resection without preoperative therapy. BMC Cancer, 2016, 16(1): 658.
16. Mohanty S, Bilimoria KY. Comparing national cancer registries: The National Cancer Data Base (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) program. J Surg Oncol, 2014, 109(7): 629-630.
17. 杨维良, 张新晨, 张东伟, 等. 35岁以下胃癌患者380例临床分析. 中华胃肠外科杂志, 2004, 7(5): 357-359.
18. Llanos O, Butte JM, Crovari F, et al. Survival of young patients after gastrectomy for gastric cancer. World J Surg, 2006, 30(1): 17-20.
19. Kim DY, Joo JK, Ryu SY, et al. Clinicopathologic characteristics of gastric carcinoma in elderly patients: a comparison with young patients. World J Gastroenterol, 2005, 11(1): 22-26.
20. Wang A, Squires MH 3rd, Melis M, et al. Stage-specific prognostic effect of race in patients with resectable gastric adenocarcinoma: an 8-institution study of the US gastric cancer collaborative. J Am Coll Surg, 2016, 222(4): 633-643.
21. Sun F, Sun H, Mo X, et al. Increased survival rates in gastric cancer, with a narrowing gender gap and widening socioeconomic status gap: a period analysis from 1984 to 2013. J Gastroenterol Hepatol, 2018, 33(4): 837-846.
22. Lauren P. The two histologic main types of gastric carcinoma: diffuse and so-called intestinal type carcinoma, an attempt at a histo-clinical classification. Acta Pathol Microbiol Scand, 1965, 64: 31-49.
23. Chen YC, Fang WL, Wang RF, et al. Clinicopathological variation of lauren classification in gastric cancer. Pathol Oncol Res, 2016, 22(1): 197-202.
24. Papachristou DN, Fortner JG. Adenocarcinoma of the gastric cardia. The choice of gastrectomy. Ann Surg, 1980, 192(1): 58-64.
25. Sugoor P, Shah S, Dusane R, et al. Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary. Langenbecks Arch Surg, 2016, 401(5): 687-697.
26. Li Z, Bai B, Xie F, et al. Distal versus total gastrectomy for middle and lower-third gastric cancer: a systematic review and meta-analysis. Int J Surg, 2018, 53: 163-170.
27. Yamamoto M, Shimokawa M, Kawano H, et al. Benefits of laparoscopic surgery compared to open standard surgery for gastric carcinoma in elderly patients: propensity score-matching analysis. Surg Endosc, 2018, [Epub ahead of print].
28. Lee JH, Park B, Joo J, et al. Body mass index and mortality in patients with gastric cancer: a large cohort study. Gastric Cancer, 2018, [Epub ahead of print].