Wu J F, Lin L S, Chen F, Liu F Q, Yan L J, Bao X D, Wang J, Wang R, Lin L K, Qiu Y, Zheng X Y, Hu Z J, Cai L, He B C
Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350108, China.
Department of Stomatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2018 Jun 10;39(6):841-846. doi: 10.3760/cma.j.issn.0254-6450.2018.06.028.
To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC). From January 2004 to June 2016, a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian. The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC. All the patients were randomly divided into two groups: modeling group (modeling dataset, =318) and validation group (validation dataset, =316). Randomization was carried out by using computer-generated random numbers. In the modeling dataset, survival rates were calculated using Kaplan-Meier method and compared using the log-rank test. Cox regression model was used to estimate the hazard ratio (s) and 95 confidence intervals (s) of prognosis factors. An PI for OSCC patients prognostic prediction model was developed based on value of each significant variable obtained from the multivariate Cox regression model. Using the tertile analysis, patients were divided into high-risk group, moderate-risk group, and low-risk group according to the PI, the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability. Results from the multivariate Cox regression model indicated that aged ≥55 years (=2.22, 95: 1.45-3.39), poor oral hygiene (=2.12, 95: 1.27-3.54), first diagnosis of lymph node metastasis (=5.78, 95: 3.60-9.27), TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (=2.43, 95: 1.10-5.37) and poor differentiation (well differentiation as reference) (=2.53, 95: 1.60-4.01) were the risk factors influencing the prognosis of OSCC. The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80, 0.700 2 and 1 150.47, 0.737 3). Age, poor oral hygiene, first diagnosis of lymph node metastasis, TNM stage and histological grade were factors associated with the prognosis of OSCC, and the PI model has a certain significance in the clinical treatment of OSCC.
探索口腔鳞状细胞癌（OSCC）的生存因素并构建预后指数（PI）。2004年1月至2016年6月，福建某医院共招募了634例经病理确诊的OSCC患者。收集所有经病理确诊的OSCC患者的临床和随访数据，以确定影响OSCC预后的因素。所有患者随机分为两组：建模组（建模数据集，n = 318）和验证组（验证数据集，n = 316）。使用计算机生成的随机数进行随机分组。在建模数据集中，采用Kaplan-Meier法计算生存率，并使用对数秩检验进行比较。采用Cox回归模型估计预后因素的风险比及95%置信区间。基于多变量Cox回归模型中每个显著变量的β值，构建OSCC患者预后预测模型的PI。采用三分位数分析，根据PI将患者分为高风险组、中风险组和低风险组，使用Akaike信息准则（AIC）和Harrell's c统计量（C指数）评估模型的预测能力。多变量Cox回归模型结果显示，年龄≥55岁（HR = 2.22，95%CI：1.45 - 3.39）、口腔卫生差（HR = 2.12，95%CI：1.27 - 3.54）、初次诊断有淋巴结转移（HR = 5.78，95%CI：3.60 - 9.27）、TNM分期Ⅲ - Ⅳ期（以Ⅰ期为参照）（HR = 2.43，95%CI：1.10 - 5.37）和低分化（以高分化为参照）（HR = 2.53，95%CI：1.60 - 4.01）是影响OSCC预后的危险因素。PI模型在建模组和验证组中具有较高的预测能力（AIC和C指数分别为1205.80、0.7002和1150.47、0.7373）。年龄、口腔卫生差、初次诊断有淋巴结转移、TNM分期和组织学分级是与OSCC预后相关的因素，PI模型在OSCC的临床治疗中具有一定意义。
