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非小细胞肺癌肝转移预后的列线图构建

Establishment of a Nomogram for prognosis of liver metastasis in patients with non-small cell lung cancer

    摘要
  • 摘要:
    目的 分析非小细胞肺癌(NSCLC)肝转移患者的临床特征及预后因素，并构建生存率列线图。
    方法 收集监测、流行病学和最终结果(SEER)数据库具有完整临床信息的NSCLC患者79 977例，分为肝转移组和非肝转移组，并将肝转移组随机分为训练集与验证集。采用χ2检验比较肝转移组的临床特征; 采用Cox回归分析筛选独立预后因素，并用于构建预测1、3年总生存率(OS)和癌症特异性生存率(CSS)的列线图。
    结果 性别、年龄、原发部位、组织学分类、病理分级、肿瘤直径、T分期、N分期、远处转移、手术、化疗、放疗与肝转移相关(P < 0.001)。多因素分析发现，性别、年龄、肿瘤直径、组织学类型、病理分级、原发部位手术、化疗、骨转移、脑转移均是OS和CSS影响的独立危险因素(P < 0.05)。受试者工作特征(ROC)曲线和校准曲线显示列线图具有良好的预测性能。基于建立的列线图对患者进行风险分层，低风险组的预后优于高风险组。
    结论 本研究构建的列线图能较为准确地预测NSCLC肝转移患者的预后情况。

     

    Abstract:
    Objective  To analyze the clinical characteristics and prognostic factors of non-small cell lung cancer (NSCLC) patients with liver metastasis, and to construct a prognostic nomogram.
    Methods  A total of 79 977 NSCLC patients with complete clinical information were collected from the Surveillance, Epidemiology, and End Results (SEER) database, and were divided into liver metastasis group and non-liver metastasis group. The liver metastasis group was randomly divided into training set and verification set. Chi square test was used to compare the clinical characteristics of liver metastasis group. The independent prognostic factors were screened by Cox regression analysis and used to construct nomograms for predicting 1- and 3-year overall survival (OS) and cancer-specific survival (CSS).
    Results  Gender, age, primary site, histological classification, pathological grade, tumor size, T stage, N stage, distant metastasis, surgery, chemotherapy, radiotherapy were related to liver metastasis (P < 0.01). Multivariate analysis found that gender, age, tumor size, histological type, pathological grade, primary site surgery, chemotherapy, bone metastasis, and brain metastasis were independent risk factor associated with OS and CSS (P < 0.05). Receiver operating characteristic (ROC) curve and calibration curve showed that the nomogram had good predictive performance. Risk stratification among patients was carried out based on the established nomograms, and the low-risk group had a better prognosis than the high-risk group.
    Conclusion  The nomograms constructed in this study can more accurately predict the prognosis of NSCLC patients with liver metastasis.

     

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