胃肠道间质瘤患者预后列线图的建立与验证:一项基于监测、流行病学和最终结果(SEER)数据库的研究

Establishment and Verification of Prognostic Nomograms for Patients with Gastrointestinal Stromal Tumors: A SEER-Based Study.

作者信息

Chen Zhan, Lin Rui-Min, Bai Yue-Kui, Zhang Yue

机构信息

Department of General Surgery, Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing, China.

Department of Hematology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.

出版信息

Biomed Res Int. 2019 Mar 27;2019:8293261. doi: 10.1155/2019/8293261. eCollection 2019.

Abstract

With gastrointestinal tract as the origin, gastrointestinal stromal tumor (GIST) is recognized as the very widespread mesenchymal tumor. A precise prognostic model of survival is required to guide the treatment options of patients with GIST. This study was designed to map the overall survival (OS) and cancer-specific survival (CSS) of GIST patients. According to the Surveillance, Epidemiology, and End Results (SEER) program database, we acquired the data of 6,713 patients with GIST who were diagnosed between 2004 and 2014. We randomly separated the patients into training (n = 4,699) and validation (n = 2,014) groups. To assess the prognostic impact of multiple clinical parameters, the Kaplan-Meier approach and the Cox proportional hazards regression model were adopted, where essential prognostic variables were combined to create nomograms. The consistency index and curve of calibration had been adopted to assess nomogram discrimination ability and prediction accuracy. A multifactor analysis of the training cohort showed that age, gender, size of tumor, location, and primary surgery were remarkably related to survival, and these variables were applied to create nomograms. The nomogram demonstrated excellent accuracy in estimating 2-, 3-, and 5-year OS and CSS, with a C-index of 0.740 (95% confidence interval [CI], 0.723-0.757) for OS and 0.743 (95% CI, 0.718-0.768) for CSS. In the validation cohort, the nomogram-predicted C-index was 0.741 for OS (95%CI, 0.717-0.765) and 0.746 (95%CI, 0.713-0.779) for CSS. All calibration curves showed good consistency between predicted and actual survival. A new nomogram was created and verified to predict the OS and CSS of patients with GIST. These new prognostic models can help enhance the accuracy of survival outcome predictions, thus facilitating to provide constructive therapeutic suggestions.

摘要

胃肠道间质瘤(GIST)起源于胃肠道,是一种非常常见的间叶组织肿瘤。需要一个精确的生存预后模型来指导GIST患者的治疗方案选择。本研究旨在绘制GIST患者的总生存期(OS)和癌症特异性生存期(CSS)。根据监测、流行病学和最终结果(SEER)计划数据库,我们获取了2004年至2014年间确诊的6713例GIST患者的数据。我们将患者随机分为训练组(n = 4699)和验证组(n = 2014)。为了评估多个临床参数的预后影响,采用了Kaplan-Meier方法和Cox比例风险回归模型,将重要的预后变量组合以创建列线图。采用一致性指数和校准曲线来评估列线图的辨别能力和预测准确性。对训练队列的多因素分析表明,年龄、性别、肿瘤大小、位置和初次手术与生存显著相关,这些变量被用于创建列线图。该列线图在估计2年、3年和5年的OS和CSS方面表现出优异的准确性,OS的C指数为0.740(95%置信区间[CI],0.723 - 0.757),CSS的C指数为0.743(95%CI,0.718 - 0.768)。在验证队列中,列线图预测的OS的C指数为0.741(95%CI,0.717 - 0.765),CSS的C指数为0.746(95%CI,0.713 - 0.779)。所有校准曲线均显示预测生存与实际生存之间具有良好的一致性。创建并验证了一个新的列线图来预测GIST患者的OS和CSS。这些新的预后模型有助于提高生存结果预测的准确性,从而有助于提供建设性的治疗建议。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1384/6457297/95172992a34a/BMRI2019-8293261.001.jpg

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