以SEER为基础的列线图构建和胰腺癌病人生存预测

摘要/Abstract

摘要：

目的：基于监测、流行病学和最终结果（surveillance, epidemiology, and end results, SEER）数据库，分析影响胰腺癌预后的独立因素并构建预测模型。方法：本研究从SEER数据库获取2010—2015年美国7 801例胰腺癌病人的临床资料，以7∶3的比例随机分为建模组、验证组。对建模组临床变量进行多因素COX回归分析获得影响生存的独立因素，构建列线图。通过受试者操作特性（receiver operating characteristic, ROC）曲线和校准曲线验证模型的准确性。结果：年龄、原发部位、病理分级、T分期、N分期、M分期、手术方式、放疗、化疗与胰腺癌的预后相关，总生存的3年、5年ROC曲线下面积（area under cure, AUC）分别为0.90、0.91，癌症特异性生存分别为0.91、0.91。校准曲线显示观察值与预测值之间具有良好的一致性。经筛选得到的临床变量确实对胰腺癌预后有影响。结论：所构建的模型具有较好的预测准确性，有助于胰腺癌病人的临床决策和个性化治疗。

关键词:胰腺癌,监测、流行病学和最终结果数据库,癌症特异性生存率,总生存率,列线图

Abstract:

ObjectiveTo analyze the independent factors affecting the prognosis of pancreatic cancer and construct a prediction model based on surveillance, epidemiology, and end results (SEER) database.MethodsThe clinical data of 7 801 American pancreatic cancer patients from 2010 to 2015 were obtained from SEER database. They were randomly divided into training group and validation group in a ratio of 7:3. The nomogram was constructed after multivariate COX regression analysis of clinical variables in the training group. The accuracy of the model was verified by receiver operating characteristic(ROC) curve and calibration curve.ResultsAge, primary-site, grade, T-stage, N-stage, M-stage，surgery, radiotherapy and chemotherapy were related to the prognosis of the patients with pancreatic cancer. The area under curve(AUC) of overall survival(OS) ROC curve of 3- and 5-year were 0.90 and 0.91 respectively. The AUC of cancer specific survival(CSS) ROC curve were 0.91 and 0.91 respectively. The calibration curve showed a good consistency between the observed and predicted values. The selected clinical variables did have an impact on the prognosis of the patients with pancreatic cancer.ConclusionsThe model had good prediction accuracy and was helpful for clinical decision-making and personalized treatment of the patients with pancreatic cancer.

Key words:Pancreatic cancer,Surveillance, epidemiology, and end results (SEER),Cancer specific survival rate,Overall survival rate,Nomogram

中图分类号:

R735.9

陆忠晓, 汤杰, 黄文海. 以SEER为基础的列线图构建和胰腺癌病人生存预测[J]. 外科理论与实践, 2024, 29(01): 46-53.

LU Zhongxiao, TANG Jie, HUANG Wenhai. Nomogram construction based on SEER and survival prediction of pancreatic cancer patients[J]. Journal of Surgery Concepts & Practice, 2024, 29(01): 46-53.

图/表7

表1

胰腺癌病人的临床病理特征[n（%）]

Variables	Total (n=7 801)	Training group (n=5 461)	Validation group (n=2 340)	P value
Age				0.41
<65	3 122(40.02)	2 169(39.72)	953(40.73)
≥65	4 679(59.98)	3 292(60.28)	1387(59.27)
Race				0.58
White	6 130(78.58)	4 294(78.63)	1 836(78.46)
African descent	1 003(12.86)	691(12.65)	312(13.33)
Other	668(8.56)	476(8.72)	192(8.21)
Sex				0.88
Male	4 094(52.48)	2 863(52.43)	1 231(52.61)
Female	3 707(47.52)	2 598(47.57)	1 109(47.39)
Primary site				0.67
Head	4 043(51.83)	2 839(51.99)	1 204(51.45)
Body and tail	3 758(48.17)	2 622(48.01)	1 136(48.55)
Grade				0.29
Ⅰ+Ⅱ	4 608(59.07)	3 247(59.46)	1 361(58.16)
Ⅲ+Ⅳ	3 193(40.93)	2 214(40.54)	979(41.84)
T stage				0.42
T1+T2	2 766(35.46)	1 952(35.74)	814(34.79)
T3+T4	5 035(64.54)	3 509(64.26)	1 526(65.21)
N stage				0.60
N0	4 993(64.00)	3 485(63.82)	1 508(64.44)
N1	2 808(36.00)	1 976(36.18)	832(35.56)
M stage				0.12
M0	4 749(60.88)	3 294(60.32)	1 455(62.18)
M1	3 052(39.12)	2 167(39.68)	885(37.82)
Surgery				0.70
No	5 505(70.57)	3 862(70.72)	1 643(70.22)
Palliative	67(0.86)	44(0.81)	23(0.98)
Radical	2 229(28.57)	1 555(28.47)	674(28.80)
Radiotherapy				0.20
No	2 296(29.43)	1 631(29.87)	665(28.42)
Yes	5 505(70.57)	3 830(70.13)	1 675(71.58)
Chemotherapy				>0.05
No	584(7.49)	428(7.84)	156(6.67)
Yes	7 217(92.51)	5 033(92.16)	2 184(93.33)

表1

表2

建模组OS的多因素COX回归分析

Variables	HR(95%CI)	βvalue	Pvalue
Age(years)
<65	-	-	-
≥65	1.55（1.46-1.65）	0.44	<0.001
Race
White	-	-	-
African descent	1.10（1.02-1.20）	0.10	0.02
Other	0.96（0.87-1.06）	-0.04	0.40
Gender
Male	-	-	-
Female	0.98（0.93-1.03）	-0.02	0.39
Primary site
Head	-	-	-
Body and tail	1.12（1.05-1.19）	0.11	<0.001
Grade
Ⅰ+Ⅱ	-	-	-
Ⅲ+Ⅳ	1.70（1.61-1.80）	0.53	<0.001
T stage
T1+T2	-	-	-
T3+T4	1.27（1.19-1.35）	0.24	<0.001
N stage
N0	-	-	-
N1	1.09（1.03-1.16）	0.09	<0.01
M stage
M0	-	-	-
M1	1.29（1.17-1.42）	0.25	<0.001
Surgery
No	-	-	-
Palliative	0.26（0.24-0.29）	-1.33	<0.001
Radical	0.21（0.14-0.32）	-1.57	<0.001
Radiotherapy
No	-	-
Yes	0.82（0.75-0.90）	-0.20	<0.001
Chemotherapy
No	-	-
Yes	0.81（0.73-0.89）	-0.21	<0.001

表2

表3

建模组CSS的多因素COX回归分析

Variables	HR(95%CI)	βvalue	Pvalue
Age(years)
<65	-	-	-
≥65	1.58（1.47-1.69）	0.46	<0.001
Race
White	-	-	-
African descent	1.11（1.01-1.22）	0.10	0.03
Other	0.94（0.83-1.06）	-0.06	0.30
Gender
Male	-	-	-
Female	0.99（0.93-1.06）	-0.01	0.85
Primary site
Head	-	-	-
Body and tail	1.16（1.08-1.25）	0.15	<0.001
Grade
Ⅰ+Ⅱ	-	-	-
Ⅲ+Ⅳ	1.70（1.59-1.82）	0.53	<0.001
T stage
T1+T2	-	-	-
T3+T4	1.30（1.21-1.40）	0.27	<0.001
N stage
N0	-	-	-
N1	1.11（1.03-1.19）	0.10	<0.01
M stage
M0	-	-	-
M1	1.34（1.20-1.50）	0.29	<0.001
Surgery
No	-	-	-
Palliative	0.27（0.24-0.30）	-1.30	<0.001
Radical	0.20（0.12-0.35）	-1.59	<0.001
Radiotherapy
No	-	-
Yes	0.84（0.75-0.94）	-0.18	<0.01
Chemotherapy
No	-	-
Yes	0.81（0.72-0.91）	-0.21	<0.001

表3

图1

图2

图3

图4

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