摘要
目的︰构建肾透明细胞癌(ccRCC)患者术后3年、5年总体生存率(OS)的个体化预测模型,并将讨其应用价值。方法︰回顾性分析2012年1月至2016年12月西京医院手术治疗的672例ecRCC患者的临床资料。男467例,女205例;中位年龄56(23~83)岁;左侧肿瘤327例,右侧肿瘤345例;临床分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期肿瘤分别为584,47,19,22例;就诊时504例无症状,168例有症状。术前碱性磷酸酶中位值80(41~240)U/L,血清白蛋白中位值44.8(30.5~59.8)g/L,中性粒细胞与淋巴细胞比值(NLR)中位值2.25(0.81~9.89),血小板计数中位值205(82~589)×10^9/L,肌酐中位值97(55~230)μmolL。420例行根治性肾切除术,252例行肾部分切除术。采用Cox多因素分析确定术后OS的独立预测因素,运用R软件整合所有独立预测因素,使其根据多因素分析所得的系数值绘制列线图模型,并通过计算一致性指数(C-index),绘制校准图对模型的性能进行检验。结果672例中位随访43(1~78)个月,其中56例死亡,死亡患者术后存活时间中位值15(1~70)个月,616例存活患者中位随访时间为44(19~78)个月。患者3年、5年0S分别为92.9%和89.2%。Cox多因素分析结果显示就诊时年龄(P<0.001),临床TNM分期(P<0.001),术前NLR(P=0.012),术前碱性磷酸酶(P=0.002)及术前白蛋白(P<0.001)是ceRCC患者术后OS的独立预测因素。整合上述5个因素的列线图模型在预测术后OS时具有良好的区分度(C-index=0.819,95%CI0.813~0.825),且校准图显示模型预测的生存结果与实际生存情况具有较高的符合度。结论︰本研究基于大样本量患者资料建立的ccRCC生存模型通过内部验证证实其性能良好;此模型可对患者术后3年.5年OS进行精准的个体化预测。
Objective To construct an effective survival nomogram for patients with clear cell renalcell carcinoma(ccRCC)using a large sample sized Chinese dataset,which can be used to predict individual3-and 5-year overall survival(o5)precisely.Methods The data of 672 ccRCC patients received operationdiagnosed at Xijing Hospital from January 2012 to December 2016 were retrospectively analyzed.There were467 males and 205 females.Their median age was 56 years old(ranging 23-83 years old).There were 327patients with tumor on the left kidney and 345 patients with tumor on the right kidney.Clinical stageⅠ,Ⅱ,Ⅲ,Ⅳ were 584,47,19 and 22 cases,respectively.At the time of diagnosis,504 patients wereasymptomatic and 168 patients were symptomatic.Preoperative alkaline phosphatase was 80(41-240)U/L.Preoperative serum albumin was 44.8(30.5-59.8)g/L.Preoperative neutrophil absolute value/lymphocyte absolute value(NLR)was 2.25(0.81-9.89).Preoperative platelet count was 205(82-589)×10^9/L.Preoperative creatinine was 97(55-230)μmol/L.Radical nephrectomy was performed in420(62.5%)patients and partial nephrectomy was performed in 252 patients.Cox multivariate analysiswas used to determine the independent predictors of the postoperative 0S.Then,the nomogram was constructed using R software,which integrates all independent predictors according to the coefficients in the multivariate analysis.Moreover,the performance of the nomogram was evaluated using the consistency index(C-index)and the calibration plots.Results Cox multivariate analysis results showed that age at diagnosis(P<0.001),clinical TNM stage(P<0.001),preoperative NLR(P=0.012),preoperative alkaline phosphatase(P=0.002)and preoperative albumin(P<0.001)were the independent predictors of postoperative OS in ccRCC patients.The nomogram established by integrating these five factors had a good discriminatory ability(C-index=0.819,95%C1 0.813-0.825),and the calibration plots showed that excellent agreements between the nomogram prediction and the actual observation were achieved.Conclusions Based on a large sample sized Chinese dataset,this study established an effective survival model for patients with ccRCC and good performance of the nomogram was demonstrated by internal validation.Our nomogram can help urologists to predict individual 3-and 5-year OS accurately for Chinese ccRCC patients.
作者
侯广东
邢自宝
郑万祥
王福利
郑昱
魏迪
张磊
敦鑫龙
袁建林
Hou Guangdong;Xing Zibao;Zheng Wanxiang;Wang Fuli;Zheng Yu;Wei Di;Zhang Lei;Dun Xinlong;Yuan Jianlin(Department of Urology,Xijing Hospital of the Air Force Medical University,Xi’an 710032,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第9期646-650,共5页
Chinese Journal of Urology
关键词
癌
肾细胞
透明细胞
预后
生存
列线图
Carcinoma,renal cell
Clear cell
Prognosis
Survival
Nomogram
作者简介
通信作者:袁建林,Email:jianliny@fmmu.edu.cn。
