Qi Feng, Wei Xiyi, Zheng Yuxiao, Sha Yeqin, Lu Yousheng, Li Xiao
Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China.
First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China.
Transl Androl Urol. 2020 Jun;9(3):1177-1191. doi: 10.21037/tau.2020.03.28.
To develop and validate survival nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) in upper tract urothelial carcinoma (UTUC) patients.
Patients diagnosed with UTUC from 2010 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively enrolled. Clinical characteristics and survival outcomes were respectively collected from the included patients. Then, eligible patients were divided into the training cohort and the validation cohort. Additionally, survival nomograms were developed based on the results of multivariate Cox analysis in the training cohort. Furthermore, Kaplan-Meier (KM) survival curves were generated to assess the actual effect of each variable. Lastly, the nomograms were validated using the concordance index (C-index), the area under the receiver operating characteristic (ROC) curve and calibration curves.
Totally, 3,556 patients were included, with 2,492 in the training cohort and 1,064 in the validation cohort. No significant differences were detected in comparisons in clinical characteristics between two cohorts. Based on the results of uni- and multivariate Cox regression analysis, seven factors (age, TNM stage, use of surgery/radiation and marital status) for OS and six factors (age, TNM stage and use of surgery/radiation) for CSS were selected to develop the survival nomograms. The C-index for OS and CSS was 0.763 and 0.793 in the training cohort, and 0.759 and 0.784 in the validation cohort. Additionally, the 3- and 5-year AUCs for OS were 0.808 and 0.780 in the training cohort, and 0.785 and 0.778 in the validation group. As for CSS, it was 0.833 and 0.803 in the training cohort, and 0.815 and 0.810 in the validation cohort. Lastly, the calibration curves indicated a good consistency between the actual survival and the predictive survival.
It was the first time to conduct survival models for UTUC patients with predictive performance. It might be valuable of clinical application and further exploration with more studies in the future.
开发并验证生存列线图，以预测上尿路尿路上皮癌（UTUC）患者的总生存期（OS）和癌症特异性生存期（CSS）。
回顾性纳入2010年至2015年在监测、流行病学和最终结果（SEER）数据库中诊断为UTUC的患者。分别收集纳入患者的临床特征和生存结果。然后，将符合条件的患者分为训练队列和验证队列。此外，基于训练队列中的多变量Cox分析结果开发生存列线图。此外，生成Kaplan-Meier（KM）生存曲线以评估每个变量的实际效果。最后，使用一致性指数（C-index）、受试者操作特征（ROC）曲线下面积和校准曲线对列线图进行验证。
共纳入3556例患者，其中训练队列2492例，验证队列1064例。两个队列的临床特征比较未发现显著差异。基于单变量和多变量Cox回归分析结果，选择7个OS因素（年龄、TNM分期、手术/放疗的使用和婚姻状况）和6个CSS因素（年龄、TNM分期和手术/放疗的使用）来开发生存列线图。训练队列中OS和CSS的C-index分别为0.763和0.793，验证队列中分别为0.759和0.784。此外，训练队列中OS的3年和5年AUC分别为0.808和0.780，验证组中分别为0.785和0.778。对于CSS，训练队列中为0.833和0.803，验证队列中为0.815和0.810。最后，校准曲线表明实际生存与预测生存之间具有良好的一致性。
首次为UTUC患者构建了具有预测性能的生存模型。它可能具有临床应用价值，并有待未来更多研究进一步探索。
