Tang Nan, Chen Zeng-Yin, Yang Zhen, Shang He-Zhen, Shi Guang-Jun
Department of Hepatobiliary, Qingdao Chengyang District People's Hospital, Qingdao, Shandong, China.
Dalian Medical University, Dalian, Liaoning, China.
Front Oncol. 2023 May 29;13:1197626. doi: 10.3389/fonc.2023.1197626. eCollection 2023.
Ampullary carcinoma (AC) is a rare cancer of the digestive system that occurs in the ampulla at the junction of the bile duct and pancreatic duct. However, there is a lack of predictive models for overall survival (OS) and disease -specific survival (DSS) in AC. This study aimed to develop a prognostic nomogram for patients with AC using data from the Surveillance, Epidemiology, and End Results Program (SEER) database.
Data from 891 patients between 2004 and 2019 were downloaded and extracted from the SEER database. They were randomly divided into the development group (70%) and the verification group (30%), and then univariate and multivariate Cox proportional hazards regression, respectively, was used to explore the possible risk factors of AC. The factors significantly related to OS and DSS were used to establish the nomogram, which was assessed the concordance index (C-index), and calibration curve. An internal validation was conducted to test the accuracy and effectiveness of the nomogram. Kaplan-Meier calculation was used to predict the further OS and DSS status of these patients.
On multivariate Cox proportional hazards regression, the independent prognostic risk factors associated with OS were age, surgery, chemotherapy, regional node positive (RNP),extension range and distant metastasis with a moderate C-index of 0.731 (95% confidence interval (CI): 0.719-0.744) and 0.766 (95% CI: 0.747-0.785) in the development and verification groups, respectively. While, marital status, surgery, chemotherapy, regional node positive (RNP),extension range and distant metastasis were significantly linked to AC patients' DSS, which have a better C-index of 0.756 (95% confidence interval (CI): 0.741-0.770) and 0.781 (95% CI: 0.757-0.805) in the development and verification groups. Both the survival calibration curves of 3- and 5-year OS and DSS brought out a high consistency.
Our study yielded a satisfactory nomogram showing the survival of AC patients, which may help clinicians to assess the situation of AC patients and implement further treatment.
壶腹癌（AC）是一种罕见的消化系统癌症，发生于胆管和胰管交界处的壶腹部。然而，目前缺乏针对壶腹癌总生存期（OS）和疾病特异性生存期（DSS）的预测模型。本研究旨在利用监测、流行病学和最终结果计划（SEER）数据库的数据，为壶腹癌患者开发一种预后列线图。
从SEER数据库下载并提取2004年至2019年间891例患者的数据。将他们随机分为开发组（70%）和验证组（30%），然后分别采用单因素和多因素Cox比例风险回归分析，探讨壶腹癌可能的危险因素。将与OS和DSS显著相关的因素用于建立列线图，并评估一致性指数（C指数）和校准曲线。进行内部验证以检验列线图的准确性和有效性。采用Kaplan-Meier计算法预测这些患者的进一步OS和DSS状态。
在多因素Cox比例风险回归分析中，与OS相关的独立预后危险因素为年龄、手术、化疗、区域淋巴结阳性（RNP）、肿瘤扩展范围和远处转移，开发组和验证组的C指数分别为0.731（95%置信区间（CI）：0.719-0.744）和0.766（95%CI：0.747-0.785），具有中等区分度。而婚姻状况、手术、化疗、区域淋巴结阳性（RNP）、肿瘤扩展范围和远处转移与壶腹癌患者的DSS显著相关，开发组和验证组的C指数分别为0.756（95%置信区间（CI）：0.741-0.770）和0.781（95%CI：0.757-0.805），区分度更好。3年和5年OS及DSS的生存校准曲线均显示出高度一致性。
我们的研究得出了一个令人满意的列线图，可显示壶腹癌患者的生存情况，这可能有助于临床医生评估壶腹癌患者的病情并实施进一步治疗。
