Prognostic factors of poorly differentiated and undifferentiated gastric cancer: a SEER database-based analysis and construction of prognostic nomogram model
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摘要:
目的 了解低分化和未分化胃癌患者预后的影响因素,并构建胃癌患者的预后诺谟图模型,为胃癌患者的生存预后评估提供参考依据。 方法 应用SEER*Stat 8.3.9.2软件提取2000 — 2018年监测、流行病学和结果(SEER)数据库中美国国立癌症研究所(NCI)登记的9223例美国部分州县医院诊断为低分化和未分化胃癌患者的相关数据,应用多因素 Cox比例风险回归模型分析患者预后的主要影响因素,并构建诺谟图模型通过校正曲线评估其对胃癌患者预后的预测价值。 结果 9223例低分化和未分化胃癌患者的平均生存时间为(31.05 ± 29.12)个月,总生存率为29.3 %,其中第1、3、5年的生存率分别为62.4 %、36.4 %、18.6 %;多因素Cox比例风险回归分析结果显示,年龄 ≥ 60岁、黑种人、肿瘤N1~N3期、肿瘤II~III期、肿瘤直径5~10 cm、原发部位为胃窦/幽门及其他部位和术前放疗是影响低分化和未分化胃癌患者预后的危险因素,女性、亚太黄种人、其他组织学类型、手术和化疗是影响低分化和未分化胃癌患者预后的保护因素;以年龄、肿瘤T分期、肿瘤N分期、肿瘤分期、是否手术、是否化疗6个因素构建1、3、5年生存率诺谟图并绘制校正曲线,结果显示,1、3、5年生存率的校正曲线与诺谟图的预测结果均吻合较好。 结论 性别、年龄、种族、肿瘤N分期、肿瘤分期、肿瘤直径、原发部位、组织学类型、手术情况、放疗情况和化疗情况是低分化和未分化胃癌患者预后的主要影响因素,本研究构建的诺谟图模型对低分化和未分化胃癌患者生存预后具有良好的预测价值。 Abstract:Objective To explore factors affecting the prognosis of poorly differentiated and undifferentiated gastric cancer and to construct a prognostic nomogram model on survival prediction of the cancer patients for providing a reference to the assessment on prognosis of gastric cancer patients. Methods The data on National Cancer Institute (NCI)-registered 9 223 patients with poorly differentiated and undifferentiated gastric cancer were extracted from the 2000 – 2018 database of Surveillance, Epidemiology, and End Results (SEER) program with SEER*Stat 8.3.9.2. Multivariate Cox proportional hazards regression model was adopted to explore main factors influencing the prognosis of the patients and nomogram diagram was constructed to evaluate main factors′ significance in prognosis prediction combined with correction curve. Results For all the patients, the average survival time was 31.05 ± 29.12 months; the overall survival rate was 29.3% and the 1-, 3-, and 5-year survival rate were 62.4%, 36.4%, and 18.6%, respectively. The results of Cox model analysis revealed that aged ≥ 60 years, black race, II/III tumor stage, first/second/third node stage, tumor size of 5 – 10 centimeters, primary tumor at antrum/pylorus and other sites than cardia/fundus or corpus of stomach, and preoperative radiotherapy were associated with a poor prognosis; while, female, Asian pacific yellow race, and tumor types other than adenocarcinoma or signet ring cell carcinoma were associated with a better prognosis. The constructed nomogram diagram based on 6 influencing factors (age, tumor stage, node stage, overall tumor staging, surgery, and chemotherapy) showed prognostic predictions well consistent with those from the correction curves for 1-, 3-, and 5-year survival rate. Conclusion The prognosis of patients with poorly differentiated and undifferentiated gastric cancer is mainly influenced by gender, age, race, node stage, overall tumor staging, tumor size, primary site, histological type, surgery, radiotherapy, and chemotherapy. The constructed nomogram diagram is of good prognostic value for predicting the patients′ survival. -
Key words:
- gastric cancer /
- poor differentiation /
- undifferentiation /
- prognosis /
- influencing factor /
- nomogram diagram /
- construction
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表 1 不同特征低分化和未分化胃癌患者生存情况比较
特征 调查人数 生存人数 生存率(%) χ2 值 P 值 性别 男性 5724 1545 26.992 31.900 < 0.001 女性 3499 1159 33.124 年龄(岁) < 60 2794 986 35.290 87.410 < 0.001 ≥ 60 6429 1718 23.723 种族 白种人 6310 1714 27.163 97.584 < 0.001 黑种人 1154 319 27.643 美洲印第安人 68 13 19.118 亚太黄种人 1691 658 38.912 肿瘤T分期 T0 8 1 12.500 635.912 < 0.001 T1 1915 809 42.245 T2 1057 479 45.317 T3 3532 970 27.463 T4 2711 445 16.415 肿瘤N分期 N0 3461 1462 42.242 563.888 < 0.001 N1 2514 629 25.020 N2 1462 379 25.923 N3 1786 234 13.102 肿瘤M分期 M0 7276 2568 35.294 1701.050 < 0.001 M1 1 947 136 6.985 肿瘤分期 I期 1641 938 57.160 2275.815 < 0.001 II期 2067 855 41.364 III期 3562 773 21.701 IV期 1 953 138 7.066 肿瘤直径(cm) < 5 4879 1761 36.093 318.167 < 0.001 5~10 3647 802 21.991 > 10 697 141 20.230 原发部位 贲门/胃底 2970 693 23.333 135.284 < 0.001 胃体 950 348 36.632 胃窦/幽门 2344 773 32.978 胃小弯/胃大弯 1458 513 35.185 其他部位 1501 377 25.117 组织学类型 胃腺癌 4009 1033 25.767 72.096 < 0.001 胃印戒细胞癌 2244 690 30.749 其他 2970 981 33.030 手术情况 未手术 2338 156 6.672 2134.613 < 0.001 手术 6885 2548 37.008 放疗情况 未放疗 6916 1 885 27.256 204.707 < 0.001 术后放疗 1624 606 37.315 术前放疗 661 203 30.711 其他 22 10 45.455 化疗情况 未化疗或不知晓 3670 1081 29.455 49.282 < 0.001 化疗 5553 1623 29.227 表 2 低分化和未分化胃癌患者预后影响因素多因素Cox比例风险回归分析
因素 参照组 β $S_{\bar x}$ Wald χ2 值 P 值 HR 值 95 % CI 性别 女性 男性 – 0.101 0.027 14.333 < 0.001 0.904 0.850~0.952 年龄(岁) ≥ 60 < 60 0.257 0.029 80.385 < 0.001 1.293 1.222~1.368 种族 黑种人 白种人 0.090 0.038 5.486 0.019 1.094 1.015~1.180 美洲印第安人 0.156 0.136 1.313 0.252 1.169 0.895~1.527 亚太黄种人 – 0.207 0.036 33.621 < 0.001 0.813 0.758~0.872 肿瘤N分期 N1 N0 0.172 0.037 21.233 < 0.001 1.188 1.104~1.278 N2 0.268 0.047 32.117 < 0.001 1.308 1.192~1.435 N3 0.686 0.046 218.347 < 0.001 1.985 1.813~2.174 肿瘤分期 II期 I期 0.637 0.061 110.115 < 0.001 1.890 1.678~2.129 III期 0.924 0.070 172.778 < 0.001 2.519 2.195~2.891 IV期 0.789 0.507 2.424 0.119 2.201 0.815~5.940 肿瘤直径(cm) 5~10 < 5 0.095 0.028 11.652 0.001 1.100 1.041~1.161 > 10 0.058 0.050 1.324 0.250 1.060 0.960~1.169 原发部位 胃体 贲门/胃底 0.040 0.050 0.666 0.414 1.041 0.945~1.148 胃窦/幽门 0.079 0.039 4.141 0.042 1.082 1.003~1.168 胃小弯/胃大弯 – 0.050 0.042 1.400 0.237 0.951 0.875~1.034 其他部位 0.139 0.042 11.172 0.001 1.150 1.059~1.248 组织学类型 胃印戒细胞癌 胃腺癌 0.039 0.033 1.415 0.234 1.040 0.975~1.109 其他 – 0.073 0.031 5.618 0.018 0.930 0.875~0.987 手术情况 手术 未手术 0.234 0.234 0.234 < 0.001 0.277 0.257~0.298 放疗情况 术后放疗 未放疗 – 0.011 0.040 0.071 0.790 0.989 0.914~1.070 术前放疗 0.459 0.059 61.074 < 0.001 1.582 1.410~1.775 其他 0.234 0.291 0.648 0.421 1.264 0.715~2.236 化疗情况 化疗 未化疗或不知晓 – 0.829 0.031 708.363 < 0.001 0.436 0.410~0.464 -
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