食管癌生存随访调查及列线图预后预测模型的建立

doi:10.3969/j.issn.1004-616x.2023.01.007

摘要/Abstract

摘要： 目的: 调查邢台地区食管癌患者生存情况，分析其预后影响因素并建立预后预测模型。方法: 选择2013年2月—2017年8月河北省退役军人总医院接诊的食管癌患者186例进行回顾性分析。收集患者人口学特征及临床、病理资料，视患者病情选择电话、门诊或住院复查的方式进行随访，根据患者首次确诊日期为生存率观察时间的起点，以末次随访时间或患者死亡事件为终点，末次随访时间为2020年12月30日。用Kaplan-Meier法进行单因素分析，以Cox回归风险模型进行多因素分析并以此构建预测模型。结果: 186例食管癌患者中男性占87.10%(162/186)，汉族占97.31%(181/186)，病理类型中鳞状细胞癌占77.42%(144/186)，临床分期Ⅲ~Ⅳ期占72.58%(135/186)。至末次随访，存活患者45例，所有患者平均生存时间为(33.48±1.72)个月，1、3、5年生存率分别为68.89%(130/186)、41.94%(78/186)、24.19%(45/186)。Cox多因素分析结果显示，有吸烟史、T3~4期、N1期、M1期为食管癌患者预后的危险因素，接受手术治疗为保护性因素(P<0.05)。食管癌患者生存风险函数表达式为h(t)=h_0(t)exp(1.038×吸烟史+0.419×T分期+1.062×N分期+0.772×M分期-1.100×手术史)，该函数指数越大风险越大，一致性指数为0.772，标准误0.013，具有较高的内部一致性。结论: 邢台地区食管癌患者5年生存率较低，该地区食管癌患者预后主要受吸烟史、T分期、N分期、M分期及手术情况的影响，以上述指标构建的列线图可用于预测食管癌患者预后。

关键词: 邢台地区, 食管癌, 生存随访, 预后因素, 多因素分析

Abstract: OBJECTIVE: To investigate survival of patients with esophageal cancers，analyze prognostic factors and establish a prognostic model. METHODS: A retrospective analysis was performed on 186 patients with esophageal cancers who were admitted to the General Hospital of Veterans of Hebei Province in Xingtai，China from February 2013 to August 2017. Demographic characteristics，and clinical and pathological data of patients were collected via telephone interviews，outpatient follow-ups or inpatient reexaminations. The first date of diagnosis of a patient was designated as the starting point of the observation time，the last follow-up time or the death event of the patient was the end point，and the last follow-up time was December 30，2020. RESULTS: Among the 186 patients，162 cases (87.10%) were males，181 cases (97.31%) were Hans，144 cases (77.42%) were squamous cell carcinomas，and 135 cases (72.58%) were in clinical stages III-IV. Up to the last follow-up time，45 patients survived，and the average survival time of all patients was (33.48 ±1.72) months. The 1-，3- and 5-year survival rates were 68.89% (130/186 cases)，41.94% (78/186) and 24.19% (45/186)，respectively. Cox multivariate analyses showed that smoking history，T3-4 stage，N1 stage and M1 stage were factors for good prognosis，and surgery was a protective factor (P<0.05). Expression of the survival risk function for the patients was h(t)=h_0(t)exp (1.038×smoking history+0.419×T stage+1.062×N stage+0.772×M stage-1.100×surgical history). The larger the function index，the greater the risk. The concordance index was 0.772 with a standard error of 0.013，with high internal consistency. CONCLUSION: The 5-year survival rate of our patients was relatively low. Their prognosis was mainly affected by smoking history，T stage，N stage，M stage and surgical status. The nomogram constructed with the above indicators can be used to predict prognosis of patients with esophageal cancers.

Key words: Xingtai area, esophageal cancer, survival follow-up, prognostic factors, multivariate analysis

中图分类号:

R735.1

路大鹏, 赵卫林, 王玉强, 路洪超, 魏双平. 食管癌生存随访调查及列线图预后预测模型的建立[J]. 癌变·畸变·突变, 2023, 35(1): 37-42.

LU Dapeng, ZHAO Weilin, WANG Yuqiang, LU Hongchao, WEI Shuangping. Survival follow-up survey of esophageal cancers and establishment of a nomogram prognosis prediction model[J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2023, 35(1): 37-42.

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