非食管鳞状细胞癌患者的预后列线图综合了基线血脂指标。
Prognostic nomogram integrated baseline serum lipids for patients with non-esophageal squamous cell carcinoma.
作者信息
Chen Shulin, Li Xiaohui, Wen Xiaoyan, Peng Songguo, Xue Ning, Xing Shan, Liu Yijun
机构信息
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Department of Urology, The First Municipal Hospital of Guangzhou, Guangzhou 510180, China.
出版信息
Ann Transl Med. 2019 Oct;7(20):548. doi: 10.21037/atm.2019.09.86.
BACKGROUND
Serum lipids have been documented as prognostic biomarkers in several types of cancer, however the prognostic value of serum lipids in non-esophageal squamous cell carcinoma (non-ESCC) is not clear. The purpose of this study was to investigate the prognostic roles of serum lipids in non-ESCC and to establish a novel effective nomogram for overall survival (OS) and disease-free survival (DFS) in patients with non-ESCC.
METHODS
We retrospectively analyzed the prognostic values of pretreatment serum lipids, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoproteinA-I (ApoAI), and apolipoprotein B (ApoB) and three lipid derivatives: atherogenic index [AI: (TC-HDL-C)/HDL-C], THR (TG/HDL-C) and LHR (LDL-C/HDL-C) in non-ESCC patients. Prognostic factors predictive of OS and DFS were determined by univariate and cox hazards analysis, and prognostic nomograms were established. The predictive power of independent prognostic factors was compared adopting time-dependent ROC. Comparisons between the nomograms and traditional TNM staging systems were evaluated using the C-index and decision curve analysis.
RESULTS
A total of 180 non-ESCC patients were recruited in this prospective study between January 2006 and December 2016. Four (cancer type, TNM stage, TC, and TG) and five (cancer type, TNM stage, TC, TG, and LDL-C) independent prognostic factors were chosen to generate the nomogram for OS and DFS, respectively. Our results showed that the area under curves (AUCs) of cancer type and TG were higher than TNM stage for OS. For DFS, however, AUCs of cancer type, TG and LDL-C were higher than the TNM stage. The C-index of the nomogram for predicting the OS was 0.69, which was significantly higher than that of TNM stage (0.58, P=0.005). In addition, for DFS, the C-index of the nomogram was significantly higher than that of the TNM stage (0.70 0.60, P=0.001). Furthermore, decision curve analysis showed that the predictive accuracy of the prognostic nomogram for OS and DFS were both higher than the TNM stage.
CONCLUSIONS
Our study demonstrated that pretreatment of serum lipids based on the prognostic nomogram could be applied to predict the OS and DFS in non-ESCC patients.
背景
血清脂质已被证明是几种癌症的预后生物标志物，然而血清脂质在非食管鳞状细胞癌（non-ESCC）中的预后价值尚不清楚。本研究的目的是探讨血清脂质在non-ESCC中的预后作用，并为non-ESCC患者建立一种新的有效的总生存（OS）和无病生存（DFS）列线图。
方法
我们回顾性分析了非ESCC患者治疗前血清脂质的预后价值，包括总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A-I（ApoAI）和载脂蛋白B（ApoB）以及三种脂质衍生物：致动脉粥样硬化指数[AI:（TC-HDL-C）/HDL-C]、THR（TG/HDL-C）和LHR（LDL-C/HDL-C）。通过单因素和Cox风险分析确定预测OS和DFS的预后因素，并建立预后列线图。采用时间依赖性ROC比较独立预后因素的预测能力。使用C指数和决策曲线分析评估列线图与传统TNM分期系统之间的差异。
结果
在2006年1月至2016年12月期间，本前瞻性研究共纳入了180例非ESCC患者。分别选择四个（癌症类型、TNM分期、TC和TG）和五个（癌症类型、TNM分期、TC、TG和LDL-C）独立预后因素来生成OS和DFS的列线图。我们的结果显示，对于OS，癌症类型和TG的曲线下面积（AUC）高于TNM分期。然而，对于DFS，癌症类型、TG和LDL-C的AUC高于TNM分期。预测OS的列线图的C指数为0.69，显著高于TNM分期（0.58，P=0.005）。此外，对于DFS，列线图的C指数显著高于TNM分期（0.70对0.60，P=0.001）。此外，决策曲线分析表明，预后列线图对OS和DFS的预测准确性均高于TNM分期。
结论
我们的研究表明，基于预后列线图的血清脂质预处理可用于预测非ESCC患者的OS和DFS。
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