| 张雨馨,徐小仙,殷卓敏.联合SCC-Ag水平建立早期宫颈鳞癌的预后预测模型[J].肿瘤学杂志,2020,26(12):1062-1067. |
| 联合SCC-Ag水平建立早期宫颈鳞癌的预后预测模型 |
| Prognostic Factors and Predictive Model for Survival of Early Cervical Squamous Cell Carcinoma |
| 投稿时间：2020-09-08 |
| DOI：10.11735/j.issn.1671-170X.2020.12.B011 |
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| 中文关键词: 早期宫颈肿瘤 列线图 总生存 血清SCC-Ag |
| 英文关键词:early cervical squamous cell carcinoma nomogram overall survival serum SCC-Ag le |
| 基金项目:浙江省公益技术应用社会发展项目（LGF19H160009） |
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| 中文摘要: |
| 摘 要：［目的］ 构建一个能够预测早期宫颈鳞癌患者术后生存的模型。［方法］ 纳入1435例在浙江省肿瘤医院行宫颈癌根治术的ⅠA～ⅡA期宫颈鳞状细胞癌患者，收集其临床特征、病理特征、术前血清SCC-Ag水平、术后辅助治疗及随访资料，随机抽取2/3患者组成建模组（n=957）用于列线图的开发，余1/3患者组成验证组（n=478）用于验证模型的性能。在建模组中，根据单因素、多因素COX回归分析结果确定影响患者总生存率的独立危险因素，结合临床意义将这些因素纳入预测模型，预测模型的区分度和准确性通过一致性指数（C-index）和校准曲线确定。进一步通过验证组评估模型的预测性能。［结果］ 在建模组中，单因素、多因素COX回归分析显示，肿块大小（HR=1.895，95%CI：1.140～3.151，P=0.014）、切缘状态（HR=3.709，95%CI：1.089～12.636，P=0.036）、脉管瘤栓（HR=2.330，95%CI：1.375～3.947，P=0.002）、术前血清SCC-Ag水平（HR=1.797，95%CI：1.131～2.858，P=0.013）、术后辅助放疗的有无（HR=0.542，95%CI 0.306～0.958，P=0.035）是早期宫颈癌的独立预后因素。结合这些因素及盆腔淋巴结状态、腹主动脉旁淋巴结状态、间质浸润，建立一个能够预测患者3年、5年OS的列线图。模型在建模组和验证组均显示出良好的区分度，C-index分别为0.71、0.69，优于FIGO分期的0.53、0.61。校准曲线也验证了该列线图预测的生存率与实际的生存率之间的一致性。［结论］本研究构建了一个有助于个体化预测早期宫颈鳞癌患者生存预后的量化模型，对于临床上制定后续的治疗方案具有一定的指导意义。 |
| 英文摘要: |
| Abstract：［Objective］ To develop a nomogram that can predict the survival of patients with early cervical squamous cell carcinoma. ［Methods］ A total of 1435 patients with stage ⅠA～ⅡA cervical squamous cell carcinoma who underwent radical surgery in Zhejiang Cancer Hospital were enrolled. Patients were randomly selected for training cohort of nomogram development(n=957) and validation cohort(n=478). In the training cohort，the univariate and multivariate analyses were performed to determine the independent risk factors for overall survival(OS)，and these factors were included in the prediction model with clinically meaningful factors. The differentiation and accuracy of the model were examined by the C-index and the calibration curve. The predictive performance of the model was tested in validation cohort. ［Results］ In the training cohort，the univariate and multivariate analyses demonstrated that tumor size(HR=1.895，95%CI：1.140～3.151，P=0.014)，margin status(HR=3.709，95%CI：1.089～12.636，P=0.036)，lymphovascular space invasion (LVSI)(HR=2.330，95%CI：1.375～3.947，P=0.002)，preoperative serum SCC-Ag level(HR=1.797，95%CI：1.131～2.858，P=0.013)，and postoperative adjuvant treatment(HR=0.542，95%CI：0.306-0.958，P=0.035) were independent risk factors for OS. A nomogram was formed using these factors integrated with pelvic lymph node status，para-aortic lymph node status，and depth of invasion(DOI) for predicting 3-year and 5-year OS of early cervical squamous cell carcinoma patients.The C-index of the training cohort and the validation cohort were 0.71 and 0.69，respectively，better than the 0.53 and 0.61 of FIGO staging. The calibration curve also verified the consistency between the predicted survival rate of the nomogram and the actual survival rate.［Conclusion］ We develop a predictive model that can help individualize and quantify the survival of patients with early cervical cancer，which has certain guiding significance for the subsequent treatment. |
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