临床荟萃 ›› 2021, Vol. 36 ›› Issue (5): 446-452.doi: 10.3969/j.issn.1004-583X.2021.05.012

• 论著 • 上一篇    下一篇

直肠癌骨转移患者预后预测列线图的构建及分析

许建发1a, 檀紫瑞1b, 李杰1c, 王淼1b, 王贵英2()   

  1. 1.河北医科大学第四医院,a.骨科;b.胸外科;c.乳腺外科,河北 石家庄 050011
    2.河北医科大学第三医院 外科,河北 石家庄 050051
  • 收稿日期:2020-10-26 出版日期:2021-05-20 发布日期:2021-06-09
  • 基金资助:
    河北省青年科技课题——妊娠对骨与软组织恶性肿瘤患者预后的影响(20201081)

Construction and analysis of forecast nomogram on prognostic patients with bone metastases from rectal cancer

Xu Jianfa1a, Tan Zirui1b, Li Jie1c, Wang Miao1b, Wang Guiying2()   

  1. 1a. Department of Orthopedics; b. Department of Thoracic Surgery; c. Breast Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
    2. Department of Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
  • Received:2020-10-26 Online:2021-05-20 Published:2021-06-09

摘要:

目的 构建预测直肠癌骨转移患者1、2年生存率的列线图,并进行验证。方法 从SEER数据库中应用SEER*Stat软件收集1973-2017年的直肠癌骨转移671例作为建模组,收集我院直肠癌骨转移108例作为验证组。应用多因素Lasso回归分析筛选影响直肠癌骨转移患者预后预测的独立因素,构建预测直肠癌骨转移患者1、2年生存率的列线图。通过C指数及临床决策曲线(DCA)对预测模型进行评价;同时,应用列线图预后模型的校正曲线进行一致性评价,应用验证组的数据进行验证,并绘制决策树帮助临床进行分类诊治。结果 直肠癌骨转移患者的年龄、组织学分级、M分期、手术情况、淋巴结转移情况、放疗及化疗7个因素是直肠癌骨转移患者预后预测的独立因素,将这些因素纳入并成功构建了列线图。建模组构建列线图所得C指数为0.75,验证组所得C指数为0.74。结论 本次研究构建的预测直肠癌骨转移患者预后生存率的列线图具有良好的预测精度,具有较强的临床应用性。

关键词: 直肠肿瘤, 肿瘤转移, 预后

Abstract:

Objective To construct and verify a forecast nomogram for 1- and 2-year survival rate of patients with bone metastasis from rectal cancer. Methods Through the SEER*Stat software, the clinical data and follow-up data of 671 patients who had diagnosis with bone metastasis in SEER database between 1973 and 2017 were included in the modeling group, and the clinical data of 108 patients with rectal cancer bone metastasis in our hospital were included as the verification group. Independent forecast factors affecting the prognostic patients with bone metastasis from rectal cancer were obtained through Multivariate Lasso regression analysis, and constructed to predict the 1- and 2-year nomogram of survival rate of patients with bone metastasis from rectal cancer. The forecast model was evaluated through C-index, clinical decision curve (DCA) and the calibration curve of nomogram prognostic model was applied to evaluate the consistency, and decision tree was drawn to help clinical diagnosis and treatment by the data of the verification group. Results Seven factors including the age, histological grade, M staging, surgery, lymph node metastasis, radiotherapy and chemotherapy were independent forecast factors for prognostic patients with bone metastasis from rectal cancer by univariate and multivariate analysis and these factors were successfully included construct the nomogram. The C-index value of the nomogram for internal validation in the modeling group was 0.75, and the C index obtained by the verification group was 0.74. Conclusion The forecast nomogram for the survival rate of prognostic patients with bone metastasis from rectal cancer constructed in this study has forecast accuracy and strong clinical applicability.

Key words: rectal tumor, neoplasm metastasis, prognosis

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