Thoracic Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, China.
Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
Front Endocrinol (Lausanne). 2023 Apr 14;14:1139222. doi: 10.3389/fendo.2023.1139222. eCollection 2023.
The purpose of this study was to build nomograms for predicting the survival of individual advanced pleural mesothelioma (MPM) patients using the Surveillance, Epidemiology, and End Results (SEER) database.
The 1251 patients enrolled from the SEER database were randomized (in a 7:3 ratio) to a training cohort and an internal validation cohort. Eighty patients were enrolled from the Harbin Medical University Cancer Hospital as the external validation cohort. Nomograms were constructed from variables screened by univariate or multivariate Cox regression analyses and evaluated by consistency indices (C-index), calibration plots, and receiver operating characteristic (ROC) curves. Patients from the SEER database who received chemotherapy alone and chemoradiotherapy were statistically paired using propensity score matching of the two groups and performed subgroup analysis in the screened variables.
The nomograms are well-structured and well-validated prognostic maps constructed from four variables: gender, histology, AJCC stage, and treatment. All individuals were allocated into high-risk versus low-risk groups based on the median risk score of the training cohort, with the high-risk group having worse OS and CSS in all three cohorts (<0.05). The outcomes of the subgroup analysis indicated that the advanced MPM patients receiving chemotherapy with or without local radiotherapy do not affect OS or CSS.
The accurate nomograms to predict the survival of patients with advanced MPM were built and validated based on an analysis of the SEER database with an external validation cohort. The study suggests that the additional local radiotherapy to chemotherapy does not increase the survival benefit of patients.
本研究旨在利用监测、流行病学和最终结果（SEER）数据库建立预测个体晚期胸膜间皮瘤（MPM）患者生存的列线图。
从 SEER 数据库中随机纳入 1251 例患者（比例为 7:3），分为训练队列和内部验证队列。从哈尔滨医科大学附属肿瘤医院纳入 80 例患者作为外部验证队列。使用单变量或多变量 Cox 回归分析筛选变量，构建列线图，并通过一致性指数（C 指数）、校准图和接收者操作特征（ROC）曲线进行评估。使用两组倾向评分匹配对 SEER 数据库中接受单纯化疗和化放疗的患者进行统计学配对，并对筛选变量进行亚组分析。
列线图是根据性别、组织学、AJCC 分期和治疗这四个变量构建的结构良好且经过充分验证的预后图。根据训练队列的中位数风险评分，所有个体均被分配到高风险组或低风险组，所有三个队列中的高风险组 OS 和 CSS 均较差（<0.05）。亚组分析结果表明，接受化疗联合或不联合局部放疗的晚期 MPM 患者的 OS 或 CSS 不受影响。
基于 SEER 数据库分析并结合外部验证队列，建立并验证了预测晚期 MPM 患者生存的准确列线图。研究表明，局部放疗联合化疗并不能增加患者的生存获益。
