食管癌单纯性骨转移183例预后因素分析及预测模型构建
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摘要
目的构建食管癌单纯骨转移预后预测模型。方法通过使用SEER Stat8.3.5软件提取2017年4月发布的SEER数据库中(2010-2015年)食管癌骨转移患者的数据,获得183例食管癌单纯性骨转移患者信息,对相关临床资料进行回顾性分析。采用秩和检验、cox比例风险模型和加速失效模型对食管癌骨转移患者的预后因素进行分析。结果年龄28～70岁的患者的预后生存时间(平均10.0个月,95%CI:7.758～12.338)较71～91岁患者(平均6.4个月,95%CI:4.365～8.428)的生存时间长(χ~2=4.077,P=0.043)。未婚患者预后(平均7.0个月)比已婚患者(平均10.5个月)差(χ~2=12.841,P<0.001)。不同病理类型的预后中,腺癌(平均10.2个月,95%CI:7.797～12.548),鳞癌(平均6.4个月,95%CI:3.895～8.899)和其他类型(平均4.0个月,95%CI:4.000～4.000)的差异具有统计学意义(χ~2=7.171,P=0.028)。不同T分期患者的预后生存差异具有统计学意义(χ~2=8.833,P=0.032)。列线图一致性指数(C-index)为0.675(95%CI:0.626～0.725)。结论单纯骨转移食管癌的预后差,婚姻、T分期与病理类型是影响预后的独立因素,而N分期对预后未显示明显的影响,列线图预测效果良好。
Objective To construct a model for predicting the prognosis of esophageal cancer bone metastasis. Methods The clinical data of 183 patients with esophageal cancer bone metastasis were analyzed retrospectively, and the prognostic factors of patients were analyzed by log-rank method and Cox proportional hazard model. Nomogram was constructed with the accelerated failure-time model.Results The average survival time(10.0 months, 95% CI:7.758-12.338) of patients aged 28-70 years was longer than that of patients aged 71-91(6.4 months, 95% CI:4.365-8.428)(χ~2=4.077, P=0.043). The prognosis of unmarried patients(average 7.0 months) was worse than that of the married(10.5 months on average)(χ~2=12.841, P<0.001). As for prognoses of different pathological types, the differences between adenocarcinoma(average 10.2 months, 95% CI:7.797-12.548), squamous cell carcinoma(average 6.4 months,95%CI:3.895-8.899) and other types(average 4.0 months, 95% CI:4.000-4.000) were statistically significant(χ~2=7.171, P=0.028).There were also significant differences between the prognoses of patients with different T stage(χ~2=8.833, P=0.032). Nomogram was constructed with the risk factors above and the C-index reached 0.675(95%CI: 0.626-0.725). Conclusion The prognosis of esophageal cancer bone metastasis was poor. Marriage, T stage, histological grade and pathological types were risk factors affecting prognosis, while N stage didn't appear to show obvious effect on prognosis. The nomogram was tested to have a good predictive capacity.
Objective To construct a model for predicting the prognosis of esophageal cancer bone metastasis. Methods The clinical data of 183 patients with esophageal cancer bone metastasis were analyzed retrospectively, and the prognostic factors of patients were analyzed by log-rank method and Cox proportional hazard model. Nomogram was constructed with the accelerated failure-time model.Results The average survival time(10.0 months, 95% CI:7.758-12.338) of patients aged 28-70 years was longer than that of patients aged 71-91(6.4 months, 95% CI:4.365-8.428)(χ~2=4.077, P=0.043). The prognosis of unmarried patients(average 7.0 months) was worse than that of the married(10.5 months on average)(χ~2=12.841, P<0.001). As for prognoses of different pathological types, the differences between adenocarcinoma(average 10.2 months, 95% CI:7.797-12.548), squamous cell carcinoma(average 6.4 months,95%CI:3.895-8.899) and other types(average 4.0 months, 95% CI:4.000-4.000) were statistically significant(χ~2=7.171, P=0.028).There were also significant differences between the prognoses of patients with different T stage(χ~2=8.833, P=0.032). Nomogram was constructed with the risk factors above and the C-index reached 0.675(95%CI: 0.626-0.725). Conclusion The prognosis of esophageal cancer bone metastasis was poor. Marriage, T stage, histological grade and pathological types were risk factors affecting prognosis, while N stage didn't appear to show obvious effect on prognosis. The nomogram was tested to have a good predictive capacity.
引文
[1]刘向明,马明全.食管癌分子靶向治疗的新进展[J].国际生物医学工程杂志,2018,41(6):549-555.
[2]朱继庆.食管癌骨转移的临床特征与预后[D].北京协和医学院;中国医学科学院;清华大学医学部;北京协和医学院中国医学科学院,2015.
[3]江舟.三维适形放射治疗对食管癌患者治疗效果的影响[J].健康前沿,2019,28(2):282.
[4]胡金敏,熊光宗,张桂林.探究食管癌同步放化疗的临床效果[J].中国继续医学教育,2019,11(1):97-99.
[5]张蕾,刘亚军,张强,等.胸上段食管癌SIB-IMRT治疗不同射野角度的剂量学比较[J].影像研究与医学应用,2019,3(2):8-10.
[6]凌毅.食管癌放射治疗的临床研究进展[J].临床医药文献电子杂志,2018,5(99):191-192.
[7]梁卫民.胸腔镜辅助三切口食管癌切除术对食管癌患者术后康复及并发症发生率的影响[J].现代医用影像学2018,27(6):2176-2177.
[8]侯小霞,常志伟,秦艳茹.食管癌靶向治疗研究进展[J].中国实用医刊,2018,45(21):122-125.
[9]覃洪斌,王海峰.食管癌微创手术的发展现状[J].微创医学2018,13(6):772-775.
[10]冯锋,戴伟,李晓东,等.食管癌骨转移患者放疗后的生存期预测模型[J].实用癌症杂志,2018,33(12):1995-1998.
[11]章鸣嬛,陈瑛,汪城,等.美国国立癌症研究所SEER数据库概述及应用[J].微型电脑应用,2015,31(12):26-28.
[12]甄婵军,周志国,乔学英,等.第7版食管癌锁骨上淋巴结转移分期方式的探讨及152例病例分析[J].中国肿瘤临床2011,38(23):1458-1463.
[13]王利利,王坚,汪建林,等.老年食管癌患者单纯放疗和同步放化疗的临床研究[J].中华放射医学与防护杂志2018,38(12):907-911.
[14]Liu Y,Xia Q,Xia J,et al.The impact of marriage on the overall survival of prostate cancer patients:A Surveillance,Epidemiology,and End Results(SEER)analysis[J].Can Urol Assoc J,2019,13(5):E135-E139
[15]Merrill RM,Johnson E.Benefits of marriage on relative and conditional relative cancer survival differ between males and females in the USA[J].J Cancer Surviv,2017,11(5):578-589.
[16]Mader L,Vetsch J,Christen S,et al.Education,employment and marriage in long-term survivors of teenage and young adult cancer compared with healthy controls[J].Swiss Med Wkly,2017147:w14419.doi:10.4414/smw.2017.14419.
[17]El IS,Pinheiro PS.The effect of marriage on stage at diagnosis and survival in women with cervical cancer[J].Psychooncology2017,26(5):704-710.
[18]Wang WP,Ni PZ,Yang YS,et al.The role and prognostic significance of aortopulmonary,anterior mediastinal,and tracheobronchial lymph nodes in esophageal cancer:update of the eighth-edition TNM staging system(2018)[J].Ann Surg Oncol,2019,26(4):1005-1011.
[19]Xia W,Liu S,Mao Q,et al.Effect of lymph node examined count on accurate staging and survival of resected esophageal cancer[J].Thorac Cancer,2019,10(5):1149-1157.
[20]Tramontano AC,Nipp R,Mercaldo ND,et al.Survival disparities by race and ethnicity in early esophageal cancer[J].Dig Dis SCI2018,63(11):2880-2888.
[21]Tran PN,Taylor TH,Klempner SJ,et al.The impact of gender,race socioeconomic status,and treatment on outcomes in esophageal cancer:A population-based analysis[J].J Carcinog,2017,16:3.
[2]朱继庆.食管癌骨转移的临床特征与预后[D].北京协和医学院;中国医学科学院;清华大学医学部;北京协和医学院中国医学科学院,2015.
[3]江舟.三维适形放射治疗对食管癌患者治疗效果的影响[J].健康前沿,2019,28(2):282.
[4]胡金敏,熊光宗,张桂林.探究食管癌同步放化疗的临床效果[J].中国继续医学教育,2019,11(1):97-99.
[5]张蕾,刘亚军,张强,等.胸上段食管癌SIB-IMRT治疗不同射野角度的剂量学比较[J].影像研究与医学应用,2019,3(2):8-10.
[6]凌毅.食管癌放射治疗的临床研究进展[J].临床医药文献电子杂志,2018,5(99):191-192.
[7]梁卫民.胸腔镜辅助三切口食管癌切除术对食管癌患者术后康复及并发症发生率的影响[J].现代医用影像学2018,27(6):2176-2177.
[8]侯小霞,常志伟,秦艳茹.食管癌靶向治疗研究进展[J].中国实用医刊,2018,45(21):122-125.
[9]覃洪斌,王海峰.食管癌微创手术的发展现状[J].微创医学2018,13(6):772-775.
[10]冯锋,戴伟,李晓东,等.食管癌骨转移患者放疗后的生存期预测模型[J].实用癌症杂志,2018,33(12):1995-1998.
[11]章鸣嬛,陈瑛,汪城,等.美国国立癌症研究所SEER数据库概述及应用[J].微型电脑应用,2015,31(12):26-28.
[12]甄婵军,周志国,乔学英,等.第7版食管癌锁骨上淋巴结转移分期方式的探讨及152例病例分析[J].中国肿瘤临床2011,38(23):1458-1463.
[13]王利利,王坚,汪建林,等.老年食管癌患者单纯放疗和同步放化疗的临床研究[J].中华放射医学与防护杂志2018,38(12):907-911.
[14]Liu Y,Xia Q,Xia J,et al.The impact of marriage on the overall survival of prostate cancer patients:A Surveillance,Epidemiology,and End Results(SEER)analysis[J].Can Urol Assoc J,2019,13(5):E135-E139
[15]Merrill RM,Johnson E.Benefits of marriage on relative and conditional relative cancer survival differ between males and females in the USA[J].J Cancer Surviv,2017,11(5):578-589.
[16]Mader L,Vetsch J,Christen S,et al.Education,employment and marriage in long-term survivors of teenage and young adult cancer compared with healthy controls[J].Swiss Med Wkly,2017147:w14419.doi:10.4414/smw.2017.14419.
[17]El IS,Pinheiro PS.The effect of marriage on stage at diagnosis and survival in women with cervical cancer[J].Psychooncology2017,26(5):704-710.
[18]Wang WP,Ni PZ,Yang YS,et al.The role and prognostic significance of aortopulmonary,anterior mediastinal,and tracheobronchial lymph nodes in esophageal cancer:update of the eighth-edition TNM staging system(2018)[J].Ann Surg Oncol,2019,26(4):1005-1011.
[19]Xia W,Liu S,Mao Q,et al.Effect of lymph node examined count on accurate staging and survival of resected esophageal cancer[J].Thorac Cancer,2019,10(5):1149-1157.
[20]Tramontano AC,Nipp R,Mercaldo ND,et al.Survival disparities by race and ethnicity in early esophageal cancer[J].Dig Dis SCI2018,63(11):2880-2888.
[21]Tran PN,Taylor TH,Klempner SJ,et al.The impact of gender,race socioeconomic status,and treatment on outcomes in esophageal cancer:A population-based analysis[J].J Carcinog,2017,16:3.