基于 SEER 数据库的回顾性研究：建立和验证用于预测成人肾肉瘤患者预后的列线图
Development and validation of a prognostic nomogram for adult patients with renal sarcoma: A retrospective study based on the SEER database.
机构信息
Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
Department of Medical College, Southeast University, Nanjing, China.
出版信息
Front Public Health. 2022 Sep 12;10:942608. doi: 10.3389/fpubh.2022.942608. eCollection 2022.
BACKGROUND
Renal sarcoma (RS) is rarely seen in clinical practice. The purpose of this study was to develop a prognostic nomogram model, which could predict the probability of overall survival (OS) and cancer-specific survival (CSS) in adult patients with RS.
METHODS
Patients diagnosed with RS were recruited from the SEER database between 2004 and 2015, and randomized to two cohorts: the training cohort and the validation cohort. Uni- and multivariate Cox regression analyses in the training cohort were used to screen independent prognostic factors for OS and CSS. Prognostic nomograms for OS and CSS were created separately for adult RS patients based on independent risk factors. The area under the receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to validate the nomograms.
RESULTS
A total of 232 eligible patients were recruited, including 162 in the training cohort and 70 in the validation cohort. Sex, histological type, SEER stage, and surgery were independent prognostic factors for OS, while histological type, SEER stage, surgery, chemotherapy were independent prognostic factors for CSS. Based on the above independent prognostic factors, prognostic nomograms for OS and CSS were created respectively. In the training cohort, the AUCs of the nomograms for OS and CSS were 0.742 and 0.733, respectively. In the validation cohort, the AUCs of the nomograms for OS and CSS were 0.837 and 0.758, respectively. The calibration curves of the nomograms showed high consistencies between the predicted and actual survival rates. Finally, the DCA demonstrated that the nomograms in the wide high-risk threshold had a higher net benefit than the SEER stage.
CONCLUSION
A prognostic nomogram for renal sarcoma was created and validated for reliability and usefulness in our study, which assisted urologists in accurately assessing the prognosis of adult RS patients.
背景
肾肉瘤（RS）在临床实践中很少见。本研究旨在建立一个预测模型，以预测成人 RS 患者的总生存（OS）和癌症特异性生存（CSS）概率。
方法
从 2004 年至 2015 年的 SEER 数据库中招募诊断为 RS 的患者，并将其随机分为两个队列：训练队列和验证队列。在训练队列中进行单变量和多变量 Cox 回归分析，以筛选 OS 和 CSS 的独立预后因素。根据独立风险因素，分别为成人 RS 患者创建 OS 和 CSS 的预测列线图。使用接收者操作特征（ROC）曲线下面积、校准曲线和决策曲线分析（DCA）来验证列线图。
结果
共纳入 232 例符合条件的患者，其中训练队列 162 例，验证队列 70 例。性别、组织学类型、SEER 分期和手术是 OS 的独立预后因素，而组织学类型、SEER 分期、手术、化疗是 CSS 的独立预后因素。基于上述独立预后因素，分别建立了 OS 和 CSS 的预测列线图。在训练队列中，OS 和 CSS 列线图的 AUC 分别为 0.742 和 0.733。在验证队列中，OS 和 CSS 列线图的 AUC 分别为 0.837 和 0.758。列线图的校准曲线显示预测生存率与实际生存率之间具有高度一致性。最后，DCA 表明，在广泛的高风险阈值下，列线图的净获益高于 SEER 分期。
结论
本研究建立并验证了肾肉瘤的预后列线图，具有可靠性和实用性，可帮助泌尿科医生准确评估成人 RS 患者的预后。
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