摘要
目的采用肺腺癌独立预后影响因素构建预测患者生存率的预后模型,为加强患者预后管理和健康生活方式干预提供方向。方法研究基于山东省肺癌高精度调查及随访数据库,以2010-2013年确诊的鲁东、鲁南和鲁西地区肺腺癌患者数据作为训练集(1218例),应用Schoenfeld残差检验和Cox比例风险模型筛选肺腺癌独立预后影响因素并构建预后模型;以2014年确诊的鲁北地区肺腺癌患者数据作为验证集(630例)进行模型验证,分别使用曲线下面积(AUC)、校准曲线和决策曲线(DCA)评估模型的区分度、校准度和临床实用性。结果最终纳入肺腺癌患者1848例,训练集和验证集5年生存率分别为30.20%和27.66%。多因素Cox回归分析显示年龄(61~75岁vs≤45岁,HR=1.396,95%CI:1.085~1.796,P=0.009;>75岁vs≤45岁,HR=2.212,95%CI:1.606~3.045,P<0.001)、吸烟史(HR=1.204,95%CI:1.016~1.427,P=0.032)、饮酒史(HR=1.239,95%CI:1.015~1.512,P=0.035)、TNM分期(ⅡvsⅠ,HR=1.958,95%CI:1.461~2.625,P<0.001;ⅢvsⅠ,HR=4.011,95%CI:3.112~5.168,P<0.001;ⅣvsⅠ,HR=5.664,95%CI:4.486~7.150,P<0.001)是影响肺腺癌预后的独立影响因素。训练集患者1、3和5年总生存期AUC值分别为0.713(95%CI:0.689~0.738)、0.776(95%CI:0.752~0.801)和0.803(95%CI:0.779~0.828);验证集1、3和5年AUC值分别为0.720(95%CI:0.696~0.745)、0.786(95%CI:0.762~0.812)和0.824(95%CI:0.800~0.849)。训练集和验证集的校准曲线表现与理想曲线均高度一致;DCA曲线显示预后模型的净效益优于TNM分期系统。结论研究构建的预后模型对于患者生存率预测有良好的鉴别和校准能力,同时具备一定的可移植性和泛化性。
Objective To construct a prognostic model for predicting survival utilizing independent prognostic influences in patients with lung adenocarcinoma(LUAD)and providing directions for strengthening the prognostic management of patients and intervention of healthy lifestyle.Methods Based on the high-precision survey and follow-up database of lung cancer in Shandong Province,this study used data of diagnosed lung adenocarcinoma patients in the eastern,southern,and western regions of Shandong Province from 2010to 2013as the training set(1218cases).Schoenfeld residual test and Cox proportional hazards model were applied to screen independent prognostic factors of lung adenocarcinoma and construct a prognostic model.The model was validated using data from 630lung adenocarcinoma patients diagnosed in the northern region of Shandong in 2014as the validation set.The area under the curve(AUC),calibration curve and decision curve(DCA)were used to evaluate the model's discrimination,calibration,and clinical practicality.Results A total of 1848patients with lung adenocarcinoma were included,and the 5-year survival rates for the training and validation sets were 30.20%and 27.66%,respectively.Multifactorial Cox regression analysis showed that age group(61-75 vs≤45,HR=1.396,95%CI:1.085-1.796,P=0.009;>75 vs≤45,HR=2.212,95%CI:1.606-3.045,P<0.001),history of smoking(HR=1.204,95%CI:1.016-1.427,P=0.032),history of alcohol consumption(HR=1.239,95%CI:1.015-1.512,P=0.035),and TNM staging(ⅡvsⅠ,HR=1.958,95%CI:1.461-2.625,P<0.001;ⅢvsⅠ,HR=4.011,95%CI:3.112-5.168,P<0.001;ⅣvsⅠ,HR=5.664,95%CI:4.486-7.150,P<0.001)were the independent influencing factors for LUAD prognosis.The AUC for the overall survival of patients in the training set at 1,3and 5years were 0.713(95%CI:0.689-0.738),0.776(95%CI:0.752-0.801)and 0.803(95%CI:0.779-0.828),respectively.The AUC for validation sets at 1,3and 5years were 0.720(95%CI:0.696-0.745),0.786(95%CI:0.762-0.812)and 0.824(95%CI:0.800-0.849),respectively.The calibration curves of the training and validation sets were highly consistent with the ideal curves.The DCA curve showed that the net benefit of the prognostic model was better than that of the TNM staging system.Conclusion The prognostic model constructed in the study has good discrimination and calibration ability for predicting patient survival rate,and also has certain portability and generalization.
作者
宋子潜
国庆
王俊红
孙浩
李秋霞
王家林
马恒敏
SONG Ziqian;GUO Qing;WANG Junhong;SUN Hao;LI Qiuxia;WANG Jialin;MA Hengmin(School of Public Health,Qilu Medical College,Shandong University,Jinan,Shandong250012,China;Feicheng People's Hospital,Feicheng,Shandong271600,China;Qingdao Municipal Hospital,Qingdao,Shandong266011,China;Shandong Medical Journal,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan,Shandong250014,China;Department of Prevention and Management,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan,Shandong250117,China)
出处
《中华肿瘤防治杂志》
北大核心
2025年第9期532-539,共8页
Chinese Journal of Cancer Prevention and Treatment
基金
国家癌症中心课题(DQGG0404)。
关键词
肺腺癌
总生存期
年龄
吸烟史
饮酒史
TNM分期
lung adenocarcinoma
overall survival period
age
smoking history
drinking history
TNM stage
作者简介
第一作者:宋子潜,男,山东济南人,硕士,主要从事流行病与卫生统计学的研究工作。E-mail:szq9568@163.com;通信作者:马恒敏,女,山东济南人,硕士,副研究员,主要从事癌症预防的研究工作。E-mail:sd_mahengmin@163.com。
