基于人群的研究：构建并验证用于预测有远处转移的上皮性卵巢癌患者生存结局的列线图。
Development and validation of a nomogram to predict survival outcome among epithelial ovarian cancer patients with site-distant metastases: a population-based study.
机构信息
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
出版信息
BMC Cancer. 2021 May 25;21(1):609. doi: 10.1186/s12885-021-07977-4.
BACKGROUND
Increasing evidence indicates that site-distant metastases are associated with survival outcomes in patients with epithelial ovarian cancer. This study aimed to investigate the prognostic values of site-distant metastases and clinical factors and develop a prognostic nomogram score individually predicting overall survival (OS, equivalent to all-cause mortality) and cancer specific survival (CSS, equivalent to cancer-specific mortality) in patients with epithelial ovarian cancer.
METHODS
We retrospectively collected data on patients with epithelial ovarian cancer from the Surveillance, Epidemiology, and End Results (SEER) database between 1975 and 2016. Multivariate Cox regression was performed to identify survival trajectories. A nomogram score was used to predict long-term survival probability. A comparison between the nomogram and the International Federation of Gynecology and Obstetrics (FIGO 2018) staging system was conducted using time-dependent receiver operating characteristic (tROC) curve.
RESULTS
A total of 131,050 patients were included, 18.2, 7.8 and 66.1% had localized, regional and distant metastases, respectively. Multivariate analysis identified several prognostic factors for OS including race, grade, histology, FIGO staging, surgery, bone metastasis, liver metastasis, lung metastasis, and lymphatic metastasis. Prognostic factors for CSS included grade, site, FIGO staging, surgery, bone metastasis, brain metastasis, lung metastasis, lymphatic metastasis, and insurance. Following bootstrap correction, the C-index of OS and CSS was 0.791 and 0.752, respectively. These nomograms showed superior performance compared with the FIGO 2018 staging criteria (P < 0.05).
CONCLUSIONS
A novel prognostic nomogram score provides better prognostic performance than the FIGO 2018 staging system. These nomograms contribute to directing clinical treatment and prognosis assessment in patients harboring site-distant metastases.
背景
越来越多的证据表明，上皮性卵巢癌患者的远处转移部位与生存结局相关。本研究旨在探讨远处转移部位和临床因素的预后价值，并建立一个预测上皮性卵巢癌患者总生存（OS，相当于全因死亡率）和癌症特异性生存（CSS，相当于癌症特异性死亡率）的预后列线图评分。
方法
我们从 1975 年至 2016 年的监测、流行病学和最终结果（SEER）数据库中回顾性收集了上皮性卵巢癌患者的数据。采用多变量 Cox 回归分析识别生存轨迹。使用列线图评分预测长期生存概率。通过时间依赖性接收者操作特征（tROC）曲线比较列线图和国际妇产科联盟（FIGO 2018）分期系统。
结果
共纳入 131050 例患者，分别有 18.2%、7.8%和 66.1%的患者为局限性、区域性和远处转移。多变量分析确定了 OS 的几个预后因素，包括种族、分级、组织学、FIGO 分期、手术、骨转移、肝转移、肺转移和淋巴转移。CSS 的预后因素包括分级、部位、FIGO 分期、手术、骨转移、脑转移、肺转移、淋巴转移和保险。经过 bootstrap 校正后，OS 和 CSS 的 C 指数分别为 0.791 和 0.752。这些列线图的表现优于 FIGO 2018 分期标准（P<0.05）。
结论
一种新的预后列线图评分提供了比 FIGO 2018 分期系统更好的预后性能。这些列线图有助于指导具有远处转移部位的患者的临床治疗和预后评估。
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