预测前列腺癌患者总生存期的列线图的开发与验证：一项基于大人群的队列研究

Development and validation of a nomogram for predicting the overall survival of prostate cancer patients: a large population-based cohort study.

作者信息

Zhou Zheng, Pu Jinxian, Wei Xuedong, Huang Yuhua, Lin Yuxin, Wang Liangliang

机构信息

Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China.

出版信息

Transl Androl Urol. 2022 Sep;11(9):1325-1335. doi: 10.21037/tau-22-498.

DOI:10.21037/tau-22-498

PMID:36217401

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9547153/

Abstract

BACKGROUND

Prostate cancer (PC) is the second most common malignant tumor, and its survival is of great concern. However, the assessment of survival risk in current studies is limited. This study is to develop and validate a nomogram for the prediction of survival in PC patients using data from the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

A total of 153,796 PC patients were included in this cohort study. Patients were divided into a training set (n=107,657) and a testing set (n=46,139). The 3-, 5- and 10-year survival of the PC patients were regarded as the outcomes. Predictors based on the demographic and pathological data for survival were identified by multivariate Cox regression analysis to develop the predictive nomogram. Internal and subgroup validations were performed to assess the predictive performance of the nomogram. The C-index, time-dependent receiver operating characteristic (ROC) curves, and corresponding areas under the ROC curves (AUCs) were used to estimate the predictive performance of the nomogram.

RESULTS

Age at diagnosis, race, marital status, tumor node metastasis (TNM) stage, prostate specific antigen (PSA) status, Gleason score, and pathological stage were identified as significantly associated with the survival of PC patients (P<0.05). The C-index of the nomogram indicated a moderate predictive ability [training set: C-index =0.782, 95% confidence interval (CI): 0.779-0.785; testing set: C-index =0.782, 95% CI: 0.777-0.787]. The AUCs of this nomogram for the 3-, 5-, and 10-year survival were 0.757 (95% CI: 0.756-0.758), 0.741 (95% CI: 0.740-0.742), and 0.716 (95% CI: 0.715-0.717), respectively. The results of subgroup validation showed that all the AUCs for the nomogram at 3, 5, and 10 years were more than 0.70, regardless of marital status and race.

CONCLUSIONS

We developed a nomogram with the moderate predictive ability for the long-term survival (3-, 5-, and 10-year survival) of patients with PC.

摘要

背景

前列腺癌（PC）是第二常见的恶性肿瘤，其生存率备受关注。然而，当前研究中对生存风险的评估有限。本研究旨在利用监测、流行病学和最终结果（SEER）数据库的数据，开发并验证一种用于预测PC患者生存情况的列线图。

方法

本队列研究共纳入153,796例PC患者。患者被分为训练集（n = 107,657）和测试集（n = 46,139）。将PC患者的3年、5年和10年生存率视为研究结局。通过多因素Cox回归分析，基于人口统计学和病理数据确定生存预测因素，以构建预测列线图。进行内部验证和亚组验证，以评估列线图的预测性能。采用C指数、时间依赖性受试者工作特征（ROC）曲线及相应的ROC曲线下面积（AUC）来估计列线图的预测性能。

结果

确诊年龄、种族、婚姻状况、肿瘤淋巴结转移（TNM）分期、前列腺特异性抗原（PSA）状态、Gleason评分和病理分期被确定为与PC患者生存显著相关（P < 0.05）。列线图的C指数显示出中等预测能力[训练集：C指数 = 0.782，95%置信区间（CI）：0.779 - 0.785；测试集：C指数 = 0.782，95% CI：0.777 - 0.787]。该列线图对3年、5年和10年生存率的AUC分别为0.757（95% CI：0.756 - 0.758）、0.741（95% CI：0.740 - 0.742）和0.716（95% CI：0.715 - 0.717）。亚组验证结果显示，无论婚姻状况和种族如何，列线图在3年、5年和10年的所有AUC均大于0.70。