基于SEER数据库的皮肤Merkel细胞癌预后分析

目的 确定皮肤Merkel细胞癌的预后因素,并构建列线图预测经手术切除的Merkel细胞癌患者的肿瘤特异性生存率。 方法 从美国国立癌症研究所的监测、流行病学、结果(SEER)数据库中收集1 271例患者,按7∶3比例采用随机数字表法分为建模组(891例)和验证组(380例)。采用单因素及多因素Cox回归分析确定预后影响因素,并将这些因素用于构建Merkel细胞癌患者的肿瘤特异性生存率的列线图。通过一致性指数(C-index)、曲线下面积(AUC)和校准曲线评价Cox比例风险模型的区分度和一致性,最后将模型的预测效果和传统TNM分期系统进行对比。 结果 Cox回归分析显示,年龄、性别、肿瘤大小、N分期、M分期和癌症特异性生存率相关,而种族、婚姻状况和放疗对肿瘤特异生存率没有显著影响。利用上述预后因素构建的列线图表现出比传统TNM分期更好地预测效果:建模组使用新模型预测,C指数为0.761,而使用TNM分期系统的C指数为0.711;新模型的AUC在建模组和验证组中均高于TNM分期。同时,2组的校准曲线一致性良好。 结论 本次构建的列线图在预测经手术切除的Merkel细胞癌患者生存率方面的效果优于第8版TNM分期系统,有助于临床医师对患者预后进行评估及个体化治疗。 

Analysis of prognostic factors for Merkel cell carcinoma based on SEER database

Objective To identify prognosis factors and construct a nomogram for predicting cancer-specific survival in patients with resected Merkel cell carcinoma. Methods A total of 1 271 patients were extracted from the Surveillance, Epidemiology and End Results database and randomly divided into training cohort(n=891) and validation cohort(n=380). Univariable and multivariable cox analysis were used to determine prognostic factors, and these factors were used to construct a nomogram for predicting cancer-specific survival in patients with resected Merkel cell carcinoma. Model performance was evaluated by Harrell's concordance index(C-index), the area under the time-dependent receiver operating characteristic curve(AUC) and calibration plots. The predictive power of the model was compared with the traditional TNM staging system. Results Cox analysis indicated age, sex, tumor size, N stage, M stage were associated with cancer-specific survival, while race, marital status and radiation therapy did not show a significant effect on outcomes. The above positive factors were employed to build a nomogram and the nomogram was superior to the 8 th TNM staging system. The C-index of the new model was 0.761, while that of the TNM staging system was 0.711. The AUC of the new model was significantly higher than that of the TNM staging system in both cohorts. Also, the nomogram displayed a good calibration. Conclusion The nomogram is superior to the 8 th TNM staging system in predicting cancer-specific survival of patients with Merkel cell carcinoma and may help doctors to evaluate the prognosis of each patient and facilitate personalized treatments.