微乳头状膀胱癌患者预后模型的建立与内部验证

侯广东; 郑昱; 魏迪; 郑万祥; 王福利; 张更; 孟平; 张磊; 鞠东恩; 袁建林

doi:10.13201/j.issn.1001-1420.2019.10.001

微乳头状膀胱癌患者预后模型的建立与内部验证

- 中国人民解放军空军军医大学西京医院泌尿外科(西安, 710032)

详细信息

通讯作者: 袁建林,E-mail:jianliny@fmmu.edu.cn

中图分类号: R737.14

收稿日期: 2019-04-16

Establishment and internal validation of the prognostic nomogram for patients with micropapillary bladder cancer

- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China

More Information

Corresponding author: YUAN Jianlin, E-mail: jianliny@fmmu.edu.cn

Received Date: 16 April 2019

摘要

摘要: 目的：探讨微乳头状膀胱癌（MPBC）患者预后的独立预测因素，并为其建立可以个体化预测预后的列线图模型。方法：回顾性分析SEER数据库中168例MPBC患者的临床资料，采用Kaplan-Meier法计算总体生存率（OS）和癌症特异性生存率（CSS），采用log-rank检验评价生存差异的显著性；采用Cox多因素回归分析确定CSS的独立预测因素，使用R软件整合所有具有独立预测意义的变量生成列线图，并采用Bootstrap法计算C-index、绘制校准曲线对模型进行内部验证。结果：年龄>75岁、黑人患者、婚姻状况异常、T₃和T₄期、≥N₁期和M₁期是CSS的独立危险因素；术后盆腔淋巴结清扫是独立保护因素。预测模型可准确预测患者预后，且其区分度优于TNM分期系统（0.745 vs.0.652）。结论：本研究基于SEER数据库建立了国内外首个可以个体化预测MPBC患者预后的列线图模型；且经内部验证，其预测性能良好。列线图模型的建立将有助于设计临床试验并促进医患沟通。
- 微乳头状膀胱癌 /
- 预后 /
- 列线图 /
- SEER数据库
Abstract: Objective: To explore the independent prognostic factors for patients with micropapillary bladder cancer(MPBC), and establish a prognostic nomogram to predict their individual prognosis. Method: The data of 168 patients registered in the SEER database were retrospectively analyzed. Overall survival(OS) and cancer-specific survival(CSS) were calculated using Kaplan-meier method and survival difference was assessed using log-rank test. Univariate and subsequent multivariate cox regression analysis were used to determine the independent predictors of CSS, and R software was used to integrate all independent predictors to generate the nomogram. Internal validation, including calculating the c-index and drawing calibration curves, was performed using bootstrap method. Result: Age>75, black patients, abnormal marital status, stage T₃ and T₄, the presence of lymph nodes metastases(≥ N₁ stage) and distant metastases(M₁ stage) were identified as independent risk factors for CSS, while dissection of pelvic lymph nodes after cystectomy was an independent protective factor. With excellent calibrations, the discriminative ability of our nomogram was better than that of the TNM staging system(0.745 vs. 0.652).Conclusion: The first prognostic nomogram for patients with MPBC was established in the current study on the basis of the SEER database, and its predictive performance was excellent demonstrated by internal validation. The development of our nomogram predicting individual 1-, 2-, and 3-year CSS would be conducive to design clinical trials and facilitate doctor-patient communication.
- micropapillary bladder cancer /
- prognosis /
- nomogram /
- SEER database

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