Construction of a survival model for patients with upper urinary tract urothelial carcinoma and its clinical application value
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摘要: 目的 构建上尿路尿路上皮癌(UTUC)患者生存模型，探究影响UTUC患者术后生存情况的风险因素及其临床应用价值。方法 选取2010年1月—2018年12月于临沂市肿瘤医院就诊的UTUC患者240例，收集患者一般临床资料，并对患者泌尿系统指标进行检测。出院后对患者进行随访，依据随访患者术后是否死亡分为死亡组(n=52)和生存组(n=188)，比较2组患者的临床数据。采用logistic多因素回归分析UTUC患者术后死亡的独立危险因素，依据患者术后死亡的独立危险因素建立列线图预测模型并验证。结果 与生存组比较，死亡组的年龄较大，且肿瘤等级高、肿瘤位于输尿管、肿瘤直径>3 cm、病理分期为T2~4、淋巴结转移、未接受辅助化疗的比例显著升高(P＜0.01)。多因素logistic回归分析结果显示：肿瘤等级高、肿瘤位于输尿管、肿瘤直径>3 cm、病理分期为T2~4、淋巴结转移为UTUC患者术后死亡的独立危险因素。依据预后独立危险因素构建列线图模型，其ROC曲线下面积为0.847(95%CI：0.805~0.839)，具有良好的区分度；Calibration曲线评价其结果显示该模型具有较高的一致性。结论 本研究构建的列线图模型可作为预测UTUC患者死亡风险的工具，预测术后生存情况，有助于为UTUC患者制定个体化治疗方案，提高患者预后生存率。Abstract: Objective To construct a survival model for patients with upper urinary tract urothelial carcinoma (UTUC), and to explore the risk factors that affect the survival of patients with UTUC and their clinical application value.Methods A total of 240 UTUC patients who were treated in Linyi Cancer Hospital from January 2010 to December 2018 were selected. Their general clinical data of the patients were collected, and the urinary system indicators of the patients were tested. After discharge, the patients were followed up for 2 years. According to whether the patients died during the follow-up, they were divided into death group (n=52) and survival group (n=188), and the clinical data of the two groups were compared. Logistic multivariate regression was used to analyze the independent risk factors of postoperative death in UTUC patients, and the nomogram prediction model was established and verified based on the independent risk factors of postoperative death of patients.Results Compared with the survival group, the death group's age was older, and the proportions of high tumor grade, tumor located in the ureter, tumor diameter > 3 cm, high pathological stage (T2-4), lymph node metastasis, and not receiving adjuvant chemotherapy significantly increased (P< 0.01). The results of multivariate logistic regression analysis showed that high tumor grade, tumor located in the ureter, tumor diameter > 3 cm, high pathological stage, and lymph node metastasis were independent risk factors for death in UTUC patients. A nomogram model was constructed based on independent prognostic risk factors, and its AUC under ROC curve was 0.847 (95%CI: 0.805-0.839), which had a good degree of discrimination; the results of the Calibration curve evaluation showed that the model had high consistency.Conclusion The nomogram model constructed in this study can be used as a tool to predict the death risk of UTUC patients, predict their postoperative survival, and help to develop individualized treatment plans for UTUC patients and improve the prognostic survival rate of patients.
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Key words:
- upper urinary tract /
- urothelial carcinoma /
- survival model /
- clinical application
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表 1 生存组与死亡组一般资料比较
例(%) 项目 生存组(n=188) 死亡组(n=52) 统计值 P值 年龄/岁 53.76± 4.74 59.21± 3.82 7.630 0.000 男性 115(61.17) 31(59.62) 0.041 0.839 糖尿病 38(20.21) 10(19.23) 0.009 0.924 高血压 55(29.26) 14(26.92) 0.108 0.742 肿瘤等级(高) 77(40.96) 31(59.62) 5.729 0.017 肿瘤位置(输尿管) 89(47.34) 34(65.38) 5.308 0.021 肿瘤多发 38(20.21) 11(21.15) 0.022 0.882 肿瘤直径(＞3 cm) 75(39.89) 30(57.69) 5.836 0.016 病理分期(T2~4) 95(50.53) 35(67.31) 4.617 0.032 淋巴结转移 8(4.26) 6(11.54) 3.933 0.047 术后未辅助化疗 112(59.57) 42(80.77) 7.958 0.005 腹腔镜式手术 152(80.85) 42(80.77) 0.000 0.989 术前肾积水 97(51.60) 28(53.85) 0.307 0.579 
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表 2 影响UTUC患者生存率的logistic多因素回归分析
变量 β SE Wald χ2 OR(95%CI) P值 年龄 0.609 0.389 2.449 1.838(1.524~4.613) 0.041 肿瘤等级 0.935 0.381 6.022 2.548(1.870~5.116) 0.015 肿瘤位置 1.205 0.926 11.840 2.903(1.870~5.116) 0.021 肿瘤直径 0.495 0.830 0.355 1.640(1.321~1.928) 0.000 病理分期 1.124 0.498 5.094 3.078(2.374~6.012) 0.000 淋巴结转移 0.131 0.630 0.043 1.140(1.045~1.628) 0.000 术后未辅助化疗 0.372 0.402 0.856 1.450(0.984~5.431) 0.234
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