基于SEER数据库构建老年鼻咽癌患者生存预后列线图

陈紫红; 钟强; 高健全; 韦翠

doi:10.16766/j.cnki.issn.1674-4152.002384

基于SEER数据库构建老年鼻咽癌患者生存预后列线图

doi: 10.16766/j.cnki.issn.1674-4152.002384

陈紫红^1, ,,
钟强²,
高健全¹,
韦翠¹

1.
梧州市红十字会医院肿瘤科三区，广西梧州 543002
2.
梧州市红十字会医院放射治疗科，广西梧州 543002

基金项目:

广西壮族自治区自筹经费科研课题 Z20190380

梧州市自筹经费科研课题 201902169

详细信息

通讯作者:
陈紫红，E-mail: 89661174@qq.com

中图分类号: R739.63 R730.7
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出版历程
- 收稿日期: 2021-04-03
- 网络出版日期: 2022-08-13

Construction of survival and prognosis nomogram for elderly nasopharyngeal carcinoma (≥ 60 years) based on SEER Database

1.
The third area of Oncology Department, Wuzhou Red Cross Hospital, Wuzhou, Guangxi 543002, China

摘要

摘要: 目的利用美国流行病学监测和结果(surveillance, epidemiology, and end results，SEER)数据库构建老年鼻咽癌患者(≥60岁)生存预后风险预测列线图，预测老年鼻咽癌患者的总生存率，为临床决策提供科学依据。方法从数据库中提取2004—2015年期间的老年鼻咽癌患者共1 366例，随机分为建模组和验证组。对建模组采用Cox比例风险回归模型分析患者的预后影响因素，再构建列线图。利用一致性指数(C-index)和校正曲线对列线图进行验证，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、婚姻、种族、肿瘤分化等级、组织学类型、TNM分期及放化疗均是老年鼻咽癌患者的预后影响因素(均P＜0.05)，均被用于构建风险预测列线图。风险预测列线图的验证结果表明，建模组的C指数为0.732(95% CI为0.708~0.756)，验证组为0.762(95% CI为0.729~0.795)；2组的校正曲线均表现出良好的一致性。结论本研究构建的老年鼻咽癌患者生存预后的风险预测列线图具有良好的预测价值，可快速准确对患者进行个体化的生存预后评估；有远处转移的80岁以上鼻咽癌患者或许是预立医疗照护计划的切入点。
- 老年 /
- 鼻咽癌 /
- 监测、流行病学和结果数据库 /
- 生存分析 /
- 风险预测列线图
Abstract: Objective To establish a nomogram to predict the overall survival (OS) rate of elderly patients with nasopharyngeal carcinoma (≥ 60 years) by utilising the database of the Surveillance, Epidemiology and End Results (SEER) program. Methods The data of 1 366 elderly patients with nasopharyngeal carcinoma who were diagnosed between 2004 and 2015 from the SEER database were obtained. These patients were randomly divided into training (n=954) and validation (n=412) cohorts. The Cox Proportional hazards regression model was performed to evaluate the prognostic effects of multiple clinicopathologic factors on OS. Significant prognostic factors were combined to build a nomogram. The predictive performance of the nomogram was evaluated via internal (training cohort data) and external validation (validation cohort data) by calculating the index of concordance (C-index) and plotting calibration curves. Results In the training cohort, the results of Cox proportional hazards regression model showed that age at diagnosis, married status, race, grade, histologic type, TNM stage, radiation and chemotherapy were significantly associated with the survival prognosis (P < 0.05). These factors were used to establish the nomogram. The nomogram showed good accuracy in predicting OS rate, with a C-index of 0.732 (95% CI: 0.708-0.756) in internal validation and a C-index of 0.762(95% CI was 0.729-0.795) in external validation. All calibration curves showed excellent consistency between prediction by nomogram and actual observation. Conclusion A novel nomogram for elderly patients with nasopharyngeal carcinoma is established to predict OS in our study and shows good prognostic significance. It can provide medical personnel with accurate and practical predictive tools which can quickly and accurately assess the survival prognosis of patients individually and guide medical personnel in the follow-up treatment of patients.
- Elderly /
- Nasopharyngeal carcinoma /
- Database of the Surveillance, Epidemiology, and End Results program /
- Survival analysis /
- Nomogram

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图 1 老年鼻咽癌患者3年与5年总生存率预测Nomogram图

Figure 1. Nomogram for predicting 3- and 5-year overall survival of elderly nasopharyngeal carcinom

下载: 全尺寸图片幻灯片

图 2 2组患者3年、5年总生存率Nomogram图的校正曲线

注：A为建模组3年总生存率校正曲线；B为建模组5年总生存率校正曲线；C为验证组3年总生存率校正曲线；D为验证组5年总生存率校正曲线。

Figure 2. Calibration plots for predicting overall survival at 3- and 5-year point

下载: 全尺寸图片幻灯片

表 1 建模组生存分析变量赋值表

Table 1. Variable assignment table of overall survival analysis in training cohort

变量	赋值方法
年龄	60~69岁=1，70~79岁=2，≥80岁=3
性别	女=1，男=2
婚姻状况	已婚=1，未婚=2，不明=3
种族	黑种人=1，白种人=2，其他人种=3
肿瘤分化等级	高分化(Ⅰ级)=1，中分化(Ⅱ级)=2，低分化(Ⅲ级)=3，未分化(Ⅳ级)=4
组织学类型	鳞癌=1，非角化性癌=2，未分化癌=3，其他未指定的=4
T分期	T0+T1期=1，T2期=2，T3期=3，T4期=4
N分期	N0期=1，N1期=2，N2期=3，N3期=4
M分期	M0期=1，M1期=2
是否放疗	是=1，否/不明=2
是否化疗	是=1，否/不明=2

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表 2 建模组和验证组患者的临床基本特征比较[例(%)]

Table 2. Comparison of clinicial basic characteristics between training cohort and validation cohort [cases (%)]

临床基本特征	建模组(n=954)	验证组(n=412)	χ²值	P值
年龄(岁)
60~69	546(57.2)	249(60.4)	3.001	0.223
70~79	290(30.4)	125(30.3)
≥80	118(12.4)	38(9.2)
性别
女性	263(27.6)	116(28.2)	0.049	0.824
男性	691(72.4)	296(71.8)
婚姻状态
已婚	595(62.4)	254(61.7)	0.219	0.896
未婚^a	307(32.2)	133(32.3)
不明	52(5.5)	25(6.1)
种族
黑种人	91(9.5)	38(9.2)	1.220	0.543
白种人	542(56.8)	247(60.0)
其他人种^b	321(33.6)	127(30.8)
肿瘤分化等级
高分化(Ⅰ级)	46(4.8)	15(3.6)	2.267	0.519
中分化(Ⅱ级)	185(19.4)	77(18.7)
低分化(Ⅲ级)	439(46.0)	183(44.4)
未分化(Ⅳ级)	284(29.8)	137(33.3)
组织学类型
鳞状细胞癌	448(47.0)	199(48.3)	1.640	0.650
非角化性癌	203(21.3)	77(18.7)
未分化癌	150(15.7)	72(17.5)
其他未指定的	153(16.0)	64(15.5)
T分期
T0+T1	303(31.8)	127(30.8)	1.525	0.677
T2	234(24.5)	101(24.5)
T3	212(22.2)	84(20.4)
T4	205(21.5)	100(24.3)
N分期
N0	351(36.8)	137(33.3)	2.698	0.440
N1	307(32.2)	138(33.5)
N2	209(21.9)	90(21.8)
N3	87(9.1)	47(11.4)
M分期
M0	860(90.1)	372(90.3)	0.007	0.934
M1	94(9.9)	40(9.7)
放射治疗
是	791(82.9)	339(82.3)	0.081	0.777
否/不明	163(17.1)	73(17.7)
化学治疗
是	708(74.2)	300(72.8)	0.291	0.590
否/不明	246(25.8)	112(27.2)
注：^a未婚包含单身、分居、离婚和丧偶^[12]。^b其他人种包括亚洲人、印第安人、阿拉斯加原住民及太平洋岛民。

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表 3 单因素生存分析结果

Table 3. Univariate analysis of overall survival

临床病理学特征	中位生存时间(月)	1年生存率	3年生存率	5年生存率	χ²值	P值
年龄(岁)
60~69	67	0.809	0.623	0.526	104.732	＜0.001
70~79	43	0.719	0.526	0.410
≥80	11	0.462	0.243	0.158
性别
女	53	0.733	0.575	0.448	0.033	0.856
男	47	0.739	0.536	0.447
婚姻状态
已婚	60	0.776	0.586	0.496	20.683	＜0.001
未婚	28	0.660	0.453	0.344
不明	104	0.788	0.631	0.512
种族
黑种人	29	0.670	0.420	0.274	11.628	0.003
白种人	41	0.708	0.530	0.440
其他	62	0.812	0.606	0.507
肿瘤分化等级
高分化(Ⅰ级)	19	0.536	0.340	0.203	51.029	＜0.001
中分化(Ⅱ级)	20	0.589	0.397	0.315
低分化(Ⅲ级)	53	0.760	0.564	0.464
未分化(Ⅳ级)	71	0.845	0.652	0.536
组织学类型
鳞状细胞癌	28	0.650	0.453	0.352	32.358	＜0.001
非角化性癌	68	0.838	0.649	0.542
未分化癌	71	0.826	0.650	0.549
其他未指定的	59	0.769	0.569	0.492
T分期
T0+T1	83	0.844	0.674	0.572	55.718	＜0.001
T2	56	0.748	0.582	0.483
T3	29	0.691	0.452	0.349
T4	22	0.623	0.415	0.321
N分期
N0	35	0.688	0.495	0.394	9.707	0.021
N1	65	0.778	0.602	0.523
N2	53	0.789	0.588	0.457
N3	28	0.690	0.461	0.372
M分期
M0	56	0.766	0.582	0.481	70.005	＜0.001
M1	12	0.496	0.217	0.125
放射治疗
是	61	0.804	0.616	0.506	157.575	＜0.001
否/不明	8	0.424	0.201	0.156
化学治疗
是	59	0.796	0.602	0.495	41.132	＜0.001
否/不明	19	0.576	0.387	0.310

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表 4 多因素Cox比例风险回归分析结果

Table 4. Multivariate Cox regression analysis of overall survival

项目	B	SE	Wald χ²	P值	RR值	95% CI
年龄(60~69岁)
70~79岁	0.308	0.101	9.280	0.002	1.361	1.116~1.659
≥80岁	0.967	0.129	56.304	＜0.001	2.630	2.043~3.385
性别(女)
男	0.183	0.102	3.215	0.073	1.201	0.983~1.467
婚姻状态(已婚)
未婚	0.247	0.095	6.752	0.009	1.280	1.062~1.541
不明	0.054	0.220	0.060	0.806	1.056	0.686~1.625
种族(黑种人)
白种人	-0.287	0.144	3.995	0.046	0.751	0.566~0.994
其他人种	-0.289	0.156	3.424	0.064	0.749	0.552~1.017
肿瘤分化等级(高分化, Ⅰ级)
中分化(Ⅱ级)	-0.207	0.194	1.136	0.287	0.813	0.556~1.190
低分化(Ⅲ级)	-0.596	0.187	10.147	0.001	0.551	0.382~0.795
未分化(Ⅳ级)	-0.527	0.223	5.587	0.018	0.590	0.381~0.914
组织学类型(鳞癌)
非角化性癌	-0.416	0.127	10.817	0.001	0.660	0.515~0.845
未分化癌	-0.444	0.194	5.242	0.022	0.641	0.438~0.938
其他未指定的	-0.090	0.143	0.392	0.531	0.914	0.690~1.211
T分期(T0+T1)
T2	0.404	0.127	10.189	0.001	1.498	1.169~1.919
T3	0.742	0.124	35.813	＜0.001	2.100	1.647~2.678
T4	0.874	0.125	48.927	＜0.001	2.396	1.876~3.061
N分期(N0)
N1	0.131	0.111	1.395	0.238	1.140	0.917~1.418
N2	0.142	0.120	1.405	0.236	1.153	0.911~1.458
N3	0.351	0.160	4.813	0.028	1.421	1.038~1.945
M分期(M0)
M1	0.707	0.132	28.683	＜0.001	2.027	1.565~2.625
是否放疗(是)
否/不明	0.909	0.116	61.512	＜0.001	2.482	1.978~3.116
是否化疗(是)
否/不明	0.348	0.112	9.616	0.002	1.416	1.137~1.764
注：括号内为对照组。

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