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甲状腺癌患者预后相关因素分析及列线图构建

  • 汶倩,张近,张艺,王欣文,温健,王晓叶,陶梅

* 通信作者: 陶梅, 单位:西安市第九医院

摘要

背景:甲状腺癌患者AJCC分期预后预测存在不足。我们的
目的是建立甲状腺癌的预后预测模型(列线图),并在甲状腺癌患者中比较两种预测模型。

方法:患者来自SEER(监测、流行病学和预后)数据库。共纳入8491例患者,分为建模队列(n=5943)和验证队列(n=2548)。采用COX回归分析在建模队列中选择变量,构建预后列线图。 在验证队列中计算c指数, ROC曲线下面积(AUC), 净重新分类指数(NRI),综合判别改善指数IDI ,校准度和决策曲线分析(DCA)来评价列线图的预测能力。

结果:共纳入12个独立的预后因素,并建立了列线图。特别是婚姻状况被首次纳入甲状腺癌生存预测模型。与AJCC预测模型相比,我们的列线图的c指数、AUC、NRI、IDI、校准度和DCA曲线均显示了较好的预测能力。

结论:我们建立了一个较准确的甲状腺癌预后预测模型-甲状腺癌预测列线图。此列线图的预后预测价值优于单独使用AJCC分期。

关键词:疾病特异性死亡;列线图;甲状腺癌

ABSTRACT

Background: The AJCC staging system is inadequate in patients with thyroid carcinomas. we aimed to establish a nomogram for thyroid cancer, and compare its prognostic value with the AJCC staging system in adults diagnosed with thyroid carcinoma.

Methods: Patients were obtained from the SEER (Surveillance, Epidemiology, and End Result) database. The 8491 included patients were divided into a modeling cohort (n=5943) and validation cohort (n=2548). The variables included in the modeling cohort were selected using a backward stepwise selection method with Cox regression, and the prognosis nomogram was constructed. In the validation cohort, we compared our survival model with the AJCC prognosis model using the concordance index (C-index), the area under the time-dependent receiver operating characteristic curve (AUC), the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), calibration plotting and decision curve analysis (DCA).

Results: Twelve independent prognostic factors were identified and establishing the nomogram. In particular, the marital status and tumor size were included in a survival-prediction model of thyroid cancer for the first time. The C-index, AUC, NRI, IDI, calibration plots and DCA curves for the nomogram showed the good performance of the nomogram compared to the AJCC staging system.

Conclusion  : We have developed and validated a highly accurate thyroid cancer prognosis nomogram. The prognostic value of the nomogram is better than that of the AJCC staging system alone.

Key words: Disease-specific death; Nomograms; Thyroid Neoplasms

引用本文 / How to Cite This Article

汶倩,张近,张艺,王欣文,温健,王晓叶,陶梅.甲状腺癌患者预后相关因素分析及列线图构建[J]. 国际精神病学杂志, , (): -

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