The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
Wuhan Central Hospital, No. 26, Shengli Street, Jiang'an District, Wuhan, China.
BMC Gastroenterol. 2023 May 23;23(1):177. doi: 10.1186/s12876-023-02802-7.
OBJECTIVE: Classical Cox proportional hazard models tend to overestimate the event probability in a competing risk setup. Due to the lack of quantitative evaluation of competitive risk data for colon cancer (CC), the present study aims to evaluate the probability of CC-specific death and construct a nomogram to quantify survival differences among CC patients. METHODS: Data on patients diagnosed with CC between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database. Patients were divided into a training dataset for the establishment of the model and a validation dataset to evaluate the performance the model at a ratio of 7:3. To evaluate the ability of multiple variables to predict cause-specific death in CC patients, univariate and multivariate analyses with Fine-Gray models were performed to screen the predictors of cause-specific death, and a nomogram for predicting cause-specific mortality was constructed. Then, the receiver operating characteristic (ROC) curve and the calibration curve were plotted to evaluate the prognostic performance of the nomogram. RESULTS: The dataset was randomly divided into a training (n = 16,655) dataset and a validation (n = 7,139) dataset at a ratio of 7:3. In the training dataset, variables including pathological subtypes of tumors, pathological grading (degree of differentiation), AJCC staging, T-staging, surgical type, lymph node surgery, chemotherapy, tumor deposits, lymph node metastasis, liver metastasis, and lung metastasis were identified as independent risk factors for cause-specific death of CC patients. Among these factors, the AJCC stage had the strongest predictive ability, and these features were used to construct the final model. In the training dataset, the consistency index (C-index) of the model was 0.848, and the areas under the receiver operating characteristic curve (AUC) at 1, 3, and 5 years was 0.852, 0.861, and 0.856, respectively. In the validation dataset, the C-index of the model was 0.847, and the AUC at 1 year, 3 years, and 5 years was 0.841, 0.862, and 0.852, respectively, indicating that this nomogram had an excellent and robust predictive performance. CONCLUSION: This study can help clinical doctors make better clinical decisions and provide better support for patients with CC.
目的:经典 Cox 比例风险模型在竞争风险设置中往往会高估事件概率。由于缺乏结肠癌(CC)竞争风险数据的定量评估,本研究旨在评估 CC 特异性死亡的概率,并构建一个列线图来量化 CC 患者的生存差异。
方法:从监测、流行病学和最终结果(SEER)数据库中收集了 2010 年至 2015 年期间诊断为 CC 的患者的数据。患者被分为训练数据集和验证数据集,比例为 7:3,用于建立模型和评估模型性能。为了评估多个变量预测 CC 患者特定原因死亡的能力,采用 Fine-Gray 模型进行单变量和多变量分析,筛选特定原因死亡的预测因子,并构建预测特定原因死亡率的列线图。然后,绘制接受者操作特征(ROC)曲线和校准曲线,以评估列线图的预后性能。
结果:数据集被随机分为训练集(n=16655)和验证集(n=7139),比例为 7:3。在训练集中,肿瘤的病理亚型、病理分级(分化程度)、AJCC 分期、T 分期、手术类型、淋巴结手术、化疗、肿瘤沉积、淋巴结转移、肝转移和肺转移等变量被确定为 CC 患者特定原因死亡的独立危险因素。在这些因素中,AJCC 分期具有最强的预测能力,并且这些特征被用于构建最终模型。在训练集中,该模型的一致性指数(C 指数)为 0.848,1、3 和 5 年的接收器操作特征曲线(AUC)面积分别为 0.852、0.861 和 0.856。在验证集中,模型的 C 指数为 0.847,1、3 和 5 年的 AUC 分别为 0.841、0.862 和 0.852,表明该列线图具有出色且稳健的预测性能。
结论:本研究有助于临床医生做出更好的临床决策,并为 CC 患者提供更好的支持。
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