Zhang Cuifen, Liu Zeyu, Tao Jiahao, Lin Lizhu, Zhai Linzhu
The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
Cancer Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
Cancer Manag Res. 2021 Dec 20;13:9271-9285. doi: 10.2147/CMAR.S339907. eCollection 2021.
Primary intestinal non-Hodgkin lymphoma (PINHL) is a biologically and clinically heterogeneous disease. Few individual prediction models are available to establish prognoses for PINHL patients. Herein, a novel nomogram was developed and verified to predict long-term cancer-specific survival (CSS) rates in PINHL patients, and a convenient online risk calculator was created using the nomogram.
Data on PINHL patients from January 1, 2004, to December 31, 2015, obtained from the Surveillance, Epidemiology, and End Results (SEER) database (n = 2372; training cohort), were analyzed by Cox regression to identify independent prognostic parameters for CSS. The nomogram was internally and externally validated in a SEER cohort (n = 1014) and a First Affiliated Hospital of Guangzhou University of Chinese Medicine (FAHGUCM) cohort (n = 37), respectively. Area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) were used to evaluate nomogram performance.
Five independent predictors were identified, namely, age, marital status, Ann Arbor Stage, B symptoms, and histologic type. The nomogram showed good performance in discrimination and calibration, with C-indices of 0.772 (95% CI: 0.754-0.790), 0.763 (95% CI: 0.734-0.792), and 0.851 (95% CI: 0.755-0.947) in the training, internal validation, and external validation cohorts, respectively. The calibration curve indicated that the nomogram was accurate, and DCA showed that the nomogram had a high clinical application value. AUC values indicated that the prediction accuracy of the nomogram was higher than that of Ann Arbor Stage (training cohort: 0.804 vs 0.630; internal validation cohort: 0.800 vs 0.637; external validation cohort: 0.811 vs 0.598), and Kaplan-Meier curves indicated the same.
A nomogram was developed to assist clinicians in predicting the survival of PINHL patients and in making optimal treatment decisions. An online calculator based on the nomogram was made available at https://cuifenzhang.shinyapps.io/DynNomapp/.
原发性肠道非霍奇金淋巴瘤（PINHL）是一种生物学和临床异质性疾病。目前几乎没有个体预测模型可用于为PINHL患者建立预后。在此，我们开发并验证了一种新型列线图，以预测PINHL患者的长期癌症特异性生存率（CSS），并使用该列线图创建了一个便捷的在线风险计算器。
分析2004年1月1日至2015年12月31日来自监测、流行病学和最终结果（SEER）数据库（n = 2372；训练队列）的PINHL患者数据，通过Cox回归确定CSS的独立预后参数。该列线图分别在一个SEER队列（n = 1014）和广州中医药大学第一附属医院（FAHGUCM）队列（n = 37）中进行内部和外部验证。采用受试者操作特征曲线（AUC）下面积、校准曲线和决策曲线分析（DCA）来评估列线图性能。
确定了五个独立预测因素，即年龄、婚姻状况、Ann Arbor分期、B症状和组织学类型。该列线图在区分度和校准方面表现良好，训练队列、内部验证队列和外部验证队列的C指数分别为0.772（95%CI：0.754 - 0.790）、0.763（95%CI：0.734 - 0.792）和0.851（95%CI：0.755 - 0.947）。校准曲线表明列线图准确，DCA表明列线图具有较高的临床应用价值。AUC值表明列线图的预测准确性高于Ann Arbor分期（训练队列：0.804对0.630；内部验证队列：0.800对0.637；外部验证队列：0.811对0.598），Kaplan - Meier曲线也表明了这一点。
开发了一种列线图，以协助临床医生预测PINHL患者的生存情况并做出最佳治疗决策。基于该列线图的在线计算器可在https://cuifenzhang.shinyapps.io/DynNomapp/获取。
