摘要
目的 基于阳性淋巴结对数比(LODDS)建立一个能够准确预测Ⅱ~Ⅲ期结直肠癌患者预后的列线图模型。方法 利用监测、流行病学和最终结果数据库(n=14212)和辽宁省肿瘤医院结直肠癌患者(n=448)数据,采用X-tile软件将LODDS分为三个等级,采用多因素Cox回归的方法筛选模型变量,建立列线图模型并进行内外部验证;绘制受试者工作特征(ROC)曲线,采用校准曲线和临床决策曲线评估模型的准确性和临床收益;采用Log-rank检验比较不同LODDS等级结直肠癌患者的生存情况。结果 T分期、LODDS等级、癌胚抗原水平和年龄是结直肠癌患者总生存期(OS)的独立影响因素,基于上述变量建立列线图模型的1、3、5年ROC曲线下面积分别为0.729、0.723和0.722。内部和外部验证显示该模型与理想模型具有良好的一致性,且在0.1~0.6的范围内能取得较好的临床收益。生存分析结果显示LODDS等级越高,患者的OS越差。结论 本模型不仅对患者预后具有准确的预测能力和良好的一致性,更能带来实际的临床获益。其优势在于可补充TNM分期的缺陷,为个体化治疗方案的制定提供科学依据。
Objective To establish a nomogram model based on the logarithmic odds of positive lymph nodes(LODDS)for accurate prognosis prediction in stageⅡ-Ⅲcolorectal cancer patients.Methods Using the Surveillance,Epidemiology,and End Results Program database(n=14212)and data from colorectal cancer patients(n=448)in Liaoning Cancer Hospital,the LODDS were stratified into three distinct prognostic tiers using X-tile software.Through multivariate Cox regression analysis,we identified significant prognostic variables and subsequently developed a comprehensive nomogram model,which underwent rigorous internal and external validation.Model performance was systematically evaluated through receiver operating characteristic(ROC)curve analysis,and calibration plots and decision curve analysis were employed to assess predictive accuracy and clinical utility.Finally,survival outcomes across different LODDS tiers were compared using Log-rank tests.Results T stage,LODDS classification,carcinoembryonic antigen level,and age were identified as independent prognostic factors for overall survival(OS)in colorectal cancer patients.A nomogram model was developed based on the above variables.When LODDS was included,the area under the ROC curve at 1,3,and 5 years of the model was 0.729,0.723 and 0.722,respectively.Both internal validation and external validation showed that the model was in good agreement with the ideal model and could achieve good clinical benefit in the range of 0.1-0.6.Survival analysis showed that the smaller the LODDS,the worse the prognosis of patients.Conclusion The model demonstrated favorable accuracy and consistency in predicting patient outcomes,with considerable clinical benefits.It could effectively compensate for the limitations of TNM staging and serve as a valuable reference for therapeutic decision-making.
作者
杨笑宇
孟庆凯
马斌
毕雪
YANG Xiaoyu;MENG Qingkai;MA Bin;BI Xue(Liaoning Cancer Hospital&Institute,Cancer Hospital of Dalian University of Technology,Cancer Hospital of China Medical University,Shenyang 110042,China)
出处
《临床肿瘤学杂志》
2025年第4期394-400,共7页
Chinese Clinical Oncology
基金
大连理工大学-辽宁省肿瘤医院医工交叉联合基金(LD2023027)。
关键词
结直肠癌
阳性淋巴结对数比
预后
列线图模型
Colorectal cancer
Logarithmic odds of positive lymph nodes
Prognosis
Nomogram model
作者简介
通讯作者:毕雪,E-mail:bixue7788@163.com。
