消化道恶性肿瘤患者预后影响因素分析和预测模型的构建
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摘要
目的:分析消化道恶性肿瘤患者预后的影响因素,并建立和探讨生存预测模型的临床应用价值。方法:回顾性分析2015年1月至2016年5月肇庆医学高等专科学校附属医院和肇庆市中医院收治的200例消化道恶性肿瘤患者的病历资料,选择可能对预后产生影响的独立危险因素,应用诺模图模型分析影响预后的因素,根据临床决策曲线对模型进行评价。结果:COX回归分析显示,年龄、肿瘤分化程度、肿瘤分期、手术史和术前化疗均为消化道恶性肿瘤患者2.5年生存率的独立影响因素(均P<0.05)。诺模图预测消化道恶性肿瘤患者的2.5年死亡率为40%时,提前对该患者进行治疗干预,可能会有约38%的患者受益。结论:年龄、肿瘤分化程度、肿瘤分期、手术史和术前化疗与消化道恶性肿瘤患者的预后有关,根据这些影响因素构建的诺模图可量化评估患者的预后。
Objective:To analyze the prognostic factors for gastrointestinal malignancy,and to investigate the value of a survival prediction model.Methods:The clinical data from 200 patients with digestive tract tumor from January 2015 to May 2016 in our hospital were retrospectively analyzed.The independent risk factors were screened and the nomogram model was established according to the screened factors.Results:COX multivariate analysis showed that the independent factors related to prognosis were age,tumor differentiation degree,tumor stage,operation history and preoperative chemotherapy.When nomogram predicted a 2.5-year mortality rate of 40% for patients with gastrointestinal malignancies, early treatment may benefit 38% of patients. Conclusion:The nomogram model established according to the age,tumor differentiation degree,tumor stage,operation history and preoperative chemotherapy could quantitatively predict the 2.5-year mortality of gastrointestinal malignancy.
Objective:To analyze the prognostic factors for gastrointestinal malignancy,and to investigate the value of a survival prediction model.Methods:The clinical data from 200 patients with digestive tract tumor from January 2015 to May 2016 in our hospital were retrospectively analyzed.The independent risk factors were screened and the nomogram model was established according to the screened factors.Results:COX multivariate analysis showed that the independent factors related to prognosis were age,tumor differentiation degree,tumor stage,operation history and preoperative chemotherapy.When nomogram predicted a 2.5-year mortality rate of 40% for patients with gastrointestinal malignancies, early treatment may benefit 38% of patients. Conclusion:The nomogram model established according to the age,tumor differentiation degree,tumor stage,operation history and preoperative chemotherapy could quantitatively predict the 2.5-year mortality of gastrointestinal malignancy.
引文
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[2] HEIKO H,MATJAZ R,HUIHUI L,et al.The p53/microRNA connection in gastrointestinal cancer[J].Clinical and Experimental Gastroenterology,2014(7):395-413.
[3] 中国1990～1992年胃癌死亡调查分析[J].中华肿瘤杂志,2002,24(1):4-8.
[4] LEVI F,RANDIMBISON L,BLANC-MOYA R,et al.Age-specific incidence of all neoplasms after colorectal cancer[J].Annals of Epidemiology,2014,24(10):785-788.
[5] 黄甜,聂绍发,柳巍,等.大肠癌患者生存时间影响因素分析[J].中国公共卫生,2008,24(1):73-74.
[6] 刘晓斌,袁智勇,尤金强,等.根治术后局部复发性直肠癌的预后因素分析[J].中华放射肿瘤学杂志,2010,19(3):223-226.
[7] BEKKAR S,GRONNIER C,MESSAGER M,et al.The Impact of preoperative radiochemotherapy on survival in advanced esophagogastric junction signet ring cell adenocarcinoma[J].The Annals of Thoracic Surgery,2014,97(1):303-310.
[8] CHAND M,RASHEED S,BHANGU A,et al.Adjuvant chemotherapy improves overall survival after TME surgery in mucinous carcinoma of the rectum[J].European Journal of Surgical Oncology(EJSO),2014,40(2):240-245.
[9] SEBAGMONTEFIORE D,STEPHENS R J,STEELE R,et al.Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer(MRC CR07 and NCIC-CTG C016):a multicentre,randomised trial[J].Lancet,2009,373(9666):811.
[10] 孟宪颖,吕传鹤,王爱光.胃肠道间质瘤51例辅助检查及生存分析[J].中国误诊学杂志,2011,11(3):678-679.
[11] KAHLERT C,PECQUEUX M,HALAMA N,et al.Tumour-site-dependent expression profile of angiogenic factors in tumour-associated stroma of primary colorectal cancer and metastases[J].British Journal of Cancer,2014,110(2):441.
[12] ZENG C,WEN W,MORGANS A K,et al.Disparities by race,age,and sex in the improvement of survival for major cancers:results from the National Cancer Institute Surveillance,Epidemiology,and End Results(SEER) Program in the United States,1990 to 2010[J].Jama Oncology,2015,1(1):88.
[13] JIM M A,PINHEIRO P S,CARREIRA H,et al.Stomach cancer survival in the United States by race and stage(2001-2009):findings from the CONCORD-2 study.[J].Cancer,2017,123(Suppl 24):5014-5036.