基于胃印戒细胞癌患者阳性淋巴结对数几率的预后列线图的开发与验证
Development and validation of prognostic nomogram based on log odds of positive lymph nodes for patients with gastric signet ring cell carcinoma.
作者信息
Xu Zijie, Jing Jing, Ma Guiliang
机构信息
Department of General Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China.
Department of Endocrinology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China.
出版信息
Chin J Cancer Res. 2020 Dec 31;32(6):778-793. doi: 10.21147/j.issn.1000-9604.2020.06.11.
OBJECTIVE
Our aims were to establish novel nomogram models, which directly targeted patients with signet ring cell carcinoma (SRC), for individualized prediction of overall survival (OS) rate and cancer-specific survival (CSS).
METHODS
We selected 1,365 SRC patients diagnosed from 2010 to 2015 from Surveillance, Epidemiology and End Results (SEER) database, and then randomly partitioned them into a training cohort and a validation cohort. Independent predicted indicators, which were identified by using univariate testing and multivariate analyses, were used to construct our prognostic nomogram models. Three methods, Harrell concordance index (C-index), receiver operating characteristics (ROC) curve and calibration curve, were used to assess the ability of discrimination and predictive accuracy. Integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision curve analysis (DCA) were used to assess clinical utility of our nomogram models.
RESULTS
Six independent predicted indicators, age, race, log odds of positive lymph nodes (LODDS), T stage, M stage and tumor size, were associated with OS rate. Nevertheless, only five independent predicted indicators were associated with CSS except race. The developed nomograms based on those independent predicted factors showed reliable discrimination. C-index of our nomogram for OS and CSS was 0.760 and 0.763, which were higher than American Joint Committee on Cancer (AJCC) 8th edition tumor-node-metastasis (TNM) staging system (0.734 and 0.741, respectively). C-index of validation cohort for OS was 0.757 and for CSS was 0.773. The calibration curves also performed good consistency. IDI, NRI and DCA showed the nomograms for both OS and CSS had a comparable clinical utility than the TNM staging system.
CONCLUSIONS
The novel nomogram models based on LODDS provided satisfying predictive ability of SRC both in OS and CSS than AJCC 8th edition TNM staging system alone.
目的
我们的目标是建立直接针对印戒细胞癌（SRC）患者的新型列线图模型，用于个体化预测总生存率（OS）和癌症特异性生存率（CSS）。
方法
我们从监测、流行病学和最终结果（SEER）数据库中选取了2010年至2015年诊断的1365例SRC患者，然后将他们随机分为训练队列和验证队列。通过单变量检验和多变量分析确定的独立预测指标用于构建我们的预后列线图模型。采用三种方法，即Harrell一致性指数（C指数）、受试者操作特征（ROC）曲线和校准曲线，来评估辨别能力和预测准确性。采用综合辨别改善（IDI）、净重新分类改善（NRI）和决策曲线分析（DCA）来评估我们列线图模型的临床实用性。
结果
六个独立预测指标，年龄、种族、阳性淋巴结对数比值（LODDS）、T分期、M分期和肿瘤大小，与OS率相关。然而，除种族外，只有五个独立预测指标与CSS相关。基于这些独立预测因素开发的列线图显示出可靠的辨别能力。我们的OS和CSS列线图的C指数分别为0.760和0.763，高于美国癌症联合委员会（AJCC）第8版肿瘤-淋巴结-转移（TNM）分期系统（分别为0.734和0.741）。验证队列的OS的C指数为0.757，CSS的C指数为0.773。校准曲线也表现出良好的一致性。IDI、NRI和DCA表明，OS和CSS的列线图与TNM分期系统相比具有相当的临床实用性。
结论
基于LODDS的新型列线图模型在SRC的OS和CSS方面比单独的AJCC第8版TNM分期系统提供了令人满意的预测能力。
Zotero 插件