原发脊柱肿瘤预后模型

Prognostic Model of Primary Spinal Tumor

摘要: 目的：探讨原发性脊柱肿瘤患者的预后相关因素并建立预测模型。方法：检索SEER数据库 (https://seer.cancer.gov/) 2004~2015年诊断为原发性脊柱肿瘤的患者。利用单因素和Cox回归分析与原发性脊柱肿瘤患者预后相关的独立危险因素。利用R语言建立列线图并采用ROC曲线、校准曲线和DCA进行评价。利用风险评分的中位数将患者分为低风险组与高风险组并采用Kaplan-Meier (K-M)生存曲线比较高低风险患者的生存情况。结果：共135例患者被纳入本研究，其中男性75例。年龄、肿瘤病理分级和N分期是原发性脊柱肿瘤患者预后相关的独立危险因素。基于3个独立预后相关因素构建列线图，其C指数为0.769，其所对应的1、2和3年的ROC曲线下面积分别为0.885、0.843和0.786。列线图的校准曲线表明该列线图预测的1、2和3年总生存率与实际生存率之间具有良好的一致性。此外，DCA结果表明该列线图在预测原发性脊柱肿瘤患者1、2及3年总生存率中具有良好的临床效用。生存曲线结果也表明2组患者间预后具有显著差异(P < 0.0001)。结论：基于年龄、肿瘤病理分级和N分期构建的列线图可以良好地预测原发性脊柱肿瘤患者的总生存率。

Abstract: Objective: To explore the prognostic factors of primary spinal tumor and establish a prognostic nomogram. Methods: The data of patients who diagnosed as primary spinal tumor between 2004~2015 were obtained from SEER database (https://seer.cancer.gov/). Univariate and multivariate Cox analyses were used to determined independent prognostic factors for primary spinal tumor patients. A nomogram was established with R and ROC curve, calibration curve, and DCA were selected to evaluate it. Patients were divided into low- and high-risk groups with the median risk score, and Kaplan-Meier survival curve was selected to show the prognosis of patients. Results: A total of 135 patients were included, including 75 male patients. Age, tumor grade and N stage were confirmed as independent prognostic factors. A nomogram was established based on three independent prognostic factors, with C-index was 0.769. The area under the ROC curve at 1-, 2-, and 3-year were 0.885, 0.843 and 0.786. The calibration curve showed favorable calibration of nomogram at 1-, 2-, and 3-year. Additionally, DCA indicated favorable clinical utilization of nomogram in predicting 1-, 2-, and 3-year overall survival for primary spinal tumor. Survival curve showed distinct prognosis between two groups (P < 0.0001). Conclusion: A nomogram incorporated age, tumor grade and N stage can favorably predict the overall survival of patients with primary spinal tumor.