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基于人群的研究:预测胃肠道间质瘤患者心血管死亡率的列线图。

Nomogram for predicting cardiovascular mortality in patients with gastrointestinal stromal tumor: A population-based study.

机构信息

Department of Cardiology, Affiliated Hospital 2 of Nantong University, Nantong, China.

Nantong Clinical Medical College of Kangda College, Nanjing Medical University, Nantong, China.

出版信息

Medicine (Baltimore). 2024 Sep 27;103(39):e39835. doi: 10.1097/MD.0000000000039835.

Abstract

This research aimed to develop and validate a clinical nomogram for predicting the probability of cardiovascular death (CVD) in patients with gastrointestinal stromal tumors (GIST). Information regarding patients diagnosed with GIST was extracted from the surveillance, epidemiology, and end results database. The multivariable competing risk model and multivariable Cox regression model were utilized to determine the independent predictive factors. A comparison was made between the results obtained from the 2 models. A nomogram was built to visualize the competing risk model. The nomogram's performance was assessed utilizing concordance index, calibrate curve, decision curve analysis, and risk stratification. A total of 9028 cases were enrolled for final analysis, with CVD accounting for 12.8% of all deaths since GIST diagnosis. The multivariate analysis of competing risks revealed that age, chemotherapy and marital status were identified as independent risk factors for CVD in GIST individuals. The nomogram model exhibited good calibration and strong discriminative ability, indicating its effectiveness in predicting outcomes, with a concordance index of 0.788 (95% confidence interval: 0.753-0.823) in the training set, and 0.744 (95% confidence interval: 0.673-0.815) in the validation set. Decision curve analysis indicated that the prediction model had good clinical practicability. Additionally, risk stratification analysis efficiently divided GIST individuals into high- and low-risk populations for CVD. This was the first research to construct and validate a predictive nomogram using a competing risk model to estimate the individual probabilities of CVD in GIST patients. The nomogram can assist clinicians in making personalized treatment and monitoring plans.

摘要

本研究旨在开发和验证一种用于预测胃肠道间质瘤(GIST)患者心血管死亡(CVD)概率的临床列线图。从监测、流行病学和最终结果数据库中提取了诊断为 GIST 的患者信息。利用多变量竞争风险模型和多变量 Cox 回归模型确定独立预测因素。比较了这两种模型的结果。构建了一个列线图来可视化竞争风险模型。通过一致性指数、校准曲线、决策曲线分析和风险分层评估列线图的性能。共纳入 9028 例患者进行最终分析,自 GIST 诊断以来,CVD 占所有死亡的 12.8%。多变量竞争风险分析显示,年龄、化疗和婚姻状况是 GIST 患者 CVD 的独立危险因素。列线图模型显示出良好的校准度和较强的判别能力,表明其在预测结局方面的有效性,在训练集中的一致性指数为 0.788(95%置信区间:0.753-0.823),在验证集中为 0.744(95%置信区间:0.673-0.815)。决策曲线分析表明,预测模型具有良好的临床实用性。此外,风险分层分析有效地将 GIST 患者分为 CVD 的高风险和低风险人群。这是第一项使用竞争风险模型构建和验证预测列线图来估计 GIST 患者 CVD 个体概率的研究。该列线图可以帮助临床医生制定个性化的治疗和监测计划。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5eed/11441931/a9d21acedcb3/medi-103-e39835-g001.jpg

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