Establishment and validation of a prognostic model for long-term survival in elderly prostate cancer patients undergoing endocrine therapy
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摘要: 目的 建立并验证老年前列腺癌(prostate cancer，PCa)患者内分泌治疗后5年生存率的预测模型。方法 回顾性分析安徽医科大学第一附属医院东城院区2010年1月—2023年8月治疗的91例老年PCa患者的临床资料。所有患者均接受内分泌治疗。采用单因素分析、LASSO回归及多因素Cox回归分析明确影响5年生存率的独立危险因素。并使用R软件建立5年生存率的Nomogram风险预测模型，采用受试者工作特征(receiver operating characteristic, ROC)曲线及Calibration校准曲线评估模型的区分能力和校准度。并使用Bootstrap法对该模型进行内部验证以评估模型的准确性，决策曲线分析(decision curve analysis，DCA)图对模型进行临床实用性评估。结果 年龄、分化程度、Gleason评分及转移情况是影响老年PCa患者5年生存率的独立影响因子(P＜0.05)。建立的预测模型ROC曲线下面积(area under curve，AUC)为0.938，显示良好的区分能力，校准曲线显示预测生存率与实际生存率有良好的一致性。内部验证显示，AUC为0.926，Calibration校准曲线在理想曲线附近。结论 基于年龄、分化程度、Gleason评分及转移情况建立的老年PCa患者内分泌治疗后5年生存率的预测模型具有较好的准确性，可为老年PCa的治疗和预后评估提供一定的指导。Abstract: Objective To establish and validate a prognostic model predicting 5-year survival rates in elderly prostate cancer(PCa) patients following endocrine therapy.Methods A retrospective analysis of the clinical data of 91 elderly PCa patients treated at East City Campus of First Affiliated Hospital of Anhui Medical University from January 2010 to August 2023. All patients underwent endocrine therapy. Univariate analysis, LASSO regression, and multivariate Cox regression were employed to identify independent risk factors affecting the 5-year survival rate. The risk prediction model for the 5-year survival rate was constructed using R software and its discriminative ability and calibration were assessed using the receiver operating characteristic(ROC) curve and calibration curve. The model's accuracy was further evaluated through internal validation using the Bootstrap method, and its clinical utility was assessed with a decision curve analysis(DCA).Results Age, differentiation degree, Gleason score, and metastasis status were identified as independent influencing factors for the 5-year survival rate in elderly PCa patients(P < 0.05). The established prediction model exhibited an area under the ROC curve(AUC) of 0.938, indicating excellent discriminative ability. The calibration curve showed good consistency between the predicted and actual survival rates. Internal validation revealed an AUC of 0.926, with the calibration curve closely aligning with the ideal curve.Conclusion The prognostic model based on age, differentiation degree, Gleason score and metastasis status for predicting the 5-year survival rate in elderly PCa patients treated with endocrine therapy demonstrates considerable accuracy, offering valuable guidance for the treatment and prognosis assessment for elderly patients with PCa.
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Key words:
- prostate cancer /
- endocrine therapy /
- overall survival rate /
- prediction model
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表 1 训练集和内部验证集患者的基线特征
例(%)，X±S 项目 训练集(64例) 内部验证集(27例) P值 年龄/岁 66.1±4.8 65.9±4.5 0.870 婚否 ＞0.999 是 58(90.6) 25(92.6) 否 6(9.4) 2(7.4) 分化 0.900 低-未分化 15(23.4) 6(22.2) 中-高分化 49(76.6) 21(77.8) 转移 0.777 是 16(25.0) 6(22.2) 否 48(75.0) 21(77.8) PSA/(ng/mL) 37.9±2.5 37.4±2.0 0.360 Gleason评分/分 7.0±2.1 6.7±2.0 0.530 
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表 2 不同结局组间变量的比较
例(%)，X±S 项目 训练集 内部验证集 存活(50例) 死亡(14例) P值 存活(20例) 死亡(7例) P值 年龄/岁 64.3±3.1 72.3±4.9 ＜0.001 65.0±3.8 68.4±5.6 0.171 婚否 ＞0.999 0.459 是 45(90.0) 13(92.9) 19(95.0) 6(85.7) 否 5(10.0) 1(7.1) 1(5.0) 1(14.3) 分化 ＜0.001 0.001 低-未分化 5(10.0) 10(71.4) 1(5.0) 5(71.4) 中-高分化 45(90.0) 4(28.6) 19(95.0) 2(28.6) 转移 ＜0.001 0.001 是 6(12.0) 10(71.4) 1(5.0) 5(71.4) 否 44(88.0) 4(28.6) 19(95.0) 2(28.6) PSA/(ng/mL) 38.0±2.4 37.5±2.7 0.505 36.8±1.5 39.2±2.2 0.004 Gleason评分/分 6.5±1.7 8.8±2.4 ＜0.001 6.2±1.4 8.0±3.0 0.042
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表 3 影响因素的单因素和多因素Cox回归分析
因素 合计 阳性事件 单因素分析 多因素分析 HR 95%CI P值 HR 95%CI P值 年龄 91 21 1.214 1.132~1.303 ＜0.001 1.158 1.062~1.263 ＜0.001 分化 低-未分化 20 14 2.237 1.043~5.828 0.039 3.277 1.168~9.230 0.020 中-高分化 71 7 0.086 0.034~0.216 ＜0.001 0.680 0.191~2.423 0.552 转移 否 69 6 — — — — 是 22 15 11.302 4.359~29.302 ＜0.001 17.236 4.009~74.103 ＜0.001 Gleason评分 91 21 1.840 1.442~2.355 ＜0.001 2.458 1.750~3.452 ＜0.001
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