预测非转移性颈段食管癌患者总生存期的列线图：一项基于监测、流行病学和最终结果（SEER）数据库的人群研究
Nomogram to predict overall survival for patients with non-metastatic cervical esophageal cancer: a SEER-based population study.
作者信息
Dong Dezuo, Zhao Dan, Li Shuai, Liu Weixin, Du Feng, Xu Xiaolong, Xiao Shaowen, Zheng Baomin, Sun Yan, Wang Weihu
机构信息
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The VIP-II Gastrointestinal Cancer Division of Medical Department, Peking University Cancer Hospital and Institute, Beijing, China.
出版信息
Ann Transl Med. 2020 Dec;8(23):1588. doi: 10.21037/atm-20-2505.
BACKGROUND
Cervical esophageal cancer (CEC) is an uncommon malignancy with poor prognosis, and there is no specific model that can be used to accurately predict the survival of patients with CEC.
METHODS
The Surveillance, Epidemiology, and End Results (SEER) database was searched for patients with non-metastatic CEC from 2004 to 2015. Overall survival (OS) and disease-specific survival (DSS) rates were calculated using the Kaplan-Meier method. Predictive factors were analyzed by Cox's proportional hazards regression, and a nomogram was created to predict survival probability using R software.
RESULTS
We identified 601 patients with CEC, 94.3% of whom had squamous cell carcinoma (SCC). The median follow-up time was 71 months. The median OS and DSS for the overall population were 15 and 18 months, respectively. There was a statistically significant decrease in surgical rates over time, from 16.7% in 2004 to 8% in 2015 (P=0.035). Comprehensive strategies consisting of two or three treatment modalities were correlated with significantly better OS and DSS (P<0.001 for both). We randomly assigned half of the patients to the training cohort (n=300) and the other half to the validation cohort (n=301). Multivariate Cox regression analysis was performed using the training cohort. Age, sex, tumor size, stages in the 7th edition of the American Joint Committee on Cancer (AJCC) staging system, and treatment with surgery, radiotherapy, or chemotherapy were identified as independent risk factors for OS. These factors were incorporated into the development of a nomogram for predicting 1-, 3-, and 5-year OS rates. The C-index of the nomogram was 0.743, which was statistically higher than that of the AJCC staging system. The internal validation, using bootstrap resampling and external validation, demonstrated the accuracy of the nomogram.
CONCLUSIONS
We developed and validated the first nomogram for CEC. This nomogram could be used to predict the OS of CEC patients with a relatively high accuracy.
背景
颈段食管癌（CEC）是一种预后较差的罕见恶性肿瘤，目前尚无可用于准确预测CEC患者生存情况的特定模型。
方法
在监测、流行病学和最终结果（SEER）数据库中搜索2004年至2015年的非转移性CEC患者。采用Kaplan-Meier法计算总生存率（OS）和疾病特异性生存率（DSS）。通过Cox比例风险回归分析预测因素，并使用R软件创建列线图以预测生存概率。
结果
我们共识别出601例CEC患者，其中94.3%为鳞状细胞癌（SCC）。中位随访时间为71个月。总体人群的中位OS和DSS分别为15个月和18个月。随着时间推移，手术率有统计学意义的下降，从2004年的16.7%降至2015年的8%（P = 0.035）。由两种或三种治疗方式组成的综合策略与显著更好的OS和DSS相关（两者P均<0.001）。我们将一半患者随机分配到训练队列（n = 300），另一半分配到验证队列（n = 301）。使用训练队列进行多变量Cox回归分析。年龄、性别、肿瘤大小、美国癌症联合委员会（AJCC）第7版分期系统中的分期以及手术、放疗或化疗治疗被确定为OS的独立危险因素。这些因素被纳入用于预测1年、3年和5年OS率的列线图的开发中。列线图的C指数为0.743，在统计学上高于AJCC分期系统。使用自举重采样的内部验证和外部验证证明了列线图的准确性。
结论
我们开发并验证了首个用于CEC的列线图。该列线图可用于相对准确地预测CEC患者的OS。
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