国际肿瘤学杂志

国际肿瘤学杂志 ›› 2019, Vol. 46 ›› Issue (9): 531-535.doi: 10.3760/cma.j.issn.1673-422X.2019.09.004

• 论著 • 上一篇    下一篇

N1-3期睾丸精原细胞瘤患者的生存研究

侯广东1,郑昱1,焦健华1,王福利1,石丰华2,张更1,孟平1,敦鑫龙1,袁建林1   

  1. 1解放军空军军医大学西京医院泌尿外科，西安710032； 2解放军空军军医大学唐都医院泌尿外科，西安710038
  • 收稿日期:2019-06-10 出版日期:2019-09-08 发布日期:2019-09-08
  • 通讯作者: 袁建林 E-mail:jianliny@fmmu.edu.cn

Survival study of patients with stage N1-3 testicular seminoma

Hou Guangdong1, Zheng Yu1, Jiao Jianhua1, Wang Fuli1, Shi Fenghua2, Zhang Geng1, Meng Ping1, Dun Xinlong1, Yuan Jianlin1   

  1. 1Department of Urology Surgery, Xijing Hospital of Air Force Medical University, Xi′an 710032, China; 2Department of Urology Surgery, Tangdu Hospital of Air Force Medical University, Xi′an 710038, China
  • Received:2019-06-10 Online:2019-09-08 Published:2019-09-08
  • Contact: Yuan Jianlin E-mail:jianliny@fmmu.edu.cn

PDF

368

PDF (Mobile)

10

摘要： 目的 探究N1-3期睾丸精原细胞瘤（TS）患者疾病特异性生存率（DSS）的独立预测因素，并构建诺模图对患者5年DSS进行个体化预测。方法 回顾性分析2004年1月至2015年12月在美国癌症研究所SEER数据库登记的N1-3期TS患者的临床病理资料。运用Kaplan-Meier法计算患者5年总生存率（OS）和DSS，log-rank检验评价亚组间的生存差异；采用Cox多因素回归分析确定DSS的独立预测因素，并运用R软件绘制诺模图。计算C-指数并绘制校准图对诺模图的预测性能进行内部验证。结果 TNM分期为ⅢA（HR=5.604，95%CI为1.252～25.083，P=0.024）、ⅢB（HR=6.710，95%CI为1.923～23.410，P=0.003）及ⅢC期（HR=13.189，95%CI为3.916～44.420，P＜0.001）、确诊时年龄≥45岁（HR=3.575，95%CI为2.014～6.344，P＜0.001）以及无配偶患者（HR=2.346，95%CI为1.406～3.914，P=0.001）是DSS的独立危险因素。经内部验证，所建诺模图的区分度为0.751（C-指数=0.751，95%CI为0.694～0.808）；且校准图显示，预测的生存情况与实际生存结果符合度较好。结论 本研究确定了确诊时年龄≥45岁、TNM分期≥ⅢA期及无配偶患者是N1-3期TS患者DSS的独立危险因素，并建立了可以个体化预测N1-3期TS患者5年DSS的诺模图。

关键词: 精原细胞瘤, 淋巴转移, 预后, 诺模图

Abstract: Objective To explore the independent predictors for disease-specific survival (DSS) rate in patients with stage N1-3 testicular seminoma (TS), and establish a nomogram to predict individual 5-year DSS. MethodsThe data of N1-3 TS patients registered in the SEER database of National Cancer Institute (USA) from January 2004 to December 2015 were retrospectively analyzed. The 5-year overall survival (OS) rate and DSS rate were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using log-rank test. Besides, the independent predictors of DSS were defined using multivariate Cox regression analysis, and nomogram was drawn using R software. Furthermore, the predictive performance of the nomogram was internally validated using the C-index and calibration plot. Results TNM stage ⅢA (HR=5.604, 95%CI: 1.252-25.083, P=0.024), ⅢB (HR=6.710, 95%CI: 1.923-23.410, P=0.003) and ⅢC (HR=13.189, 95%CI: 3.916-44.420, P＜0.001), age at diagnosis ≥45 years old (HR=3.575, 95%CI: 2.014-6.344, P＜0.001), and patients without spouse (HR=2.346, 95%CI: 1.406-3.914, P=0.001) were identified as independent risk factors for DSS. On internal validation, the predictive accuracy of our nomogram was 0.751 (C-index: 0.751, 95%CI: 0.694-0.808). Besides, the calibration plot showed that the predicted survival outcomes were highly consistent with the actual survival outcomes. Conclusion The study confirms that age at diagnosis ≥45 years old, TNM stage ≥ⅢA and patients without spouse are the independent risk factors for DSS in TS patients with stage N1-3, and the nomogram for predicting individual 5-year DSS is established.

Key words: Seminoma, Lymphatic metastasis, Prognosis, Nomogram