■胰腺癌(PC)患者预后不良。放射治疗(RT)是临床实践中的标准姑息治疗方法,目前尚无有效的临床预测模型来预测接受放疗的PC患者的预后。本研究旨在分析PC的临床特征,找出影响PC患者预后的因素,并构建视觉列线图来预测总生存期(OS)。
■SEER*Stat软件用于从监测中收集临床数据,流行病学,和3570例接受RT治疗的患者的最终结果(SEER)数据库。同时,收集郑州大学附属肿瘤医院115例患者的相关临床资料。SEER数据库数据以7:3的比例随机分为训练和内部验证队列,以郑州大学附属肿瘤医院所有患者为外部验证队列。套索回归用于筛选相关变量。所有非零变量都包括在多变量分析中。多因素Cox比例风险回归分析确定独立预后因素。Kaplan-Meier(K-M)方法用于绘制不同治疗方法(手术,RT,化疗,和联合治疗)并计算中位OS。列线图用于预测1年、3年和5年的生存率。并用计算曲线绘制了随时间变化的受试者工作特征曲线(ROC)。计算曲线下面积(AUC),Bootstrap方法用于绘制校准曲线,采用决策曲线分析(DCA)评价预测模型的临床疗效。
■手术联合放化疗(SCRT)的中位OS分别为25.0、18.0、11.0和4.0个月,手术联合放疗,放化疗(CRT),和RT单独队列,分别。多因素Cox回归分析显示,年龄,N级,M阶段,化疗,手术,淋巴结手术,和分级是患者的独立预后因素。构建列线图模型来预测患者的OS。1-,3-,绘制了5年随时间变化的ROC曲线,并计算AUC值。结果表明,训练队列的AUC分别为0.77、0.79和0.79,内部验证队列的0.79、0.82和0.81,外部验证队列为0.73、0.93和0.88。校正曲线表明,模型预测概率与实际观测概率高度吻合,DCA曲线显示了较高的净收益。
■SCRT显着改善了PC患者的操作系统。我们开发并验证了Nomogram来预测接受RT的PC患者的操作系统。
Patients with pancreatic cancer (PC) have a poor prognosis. Radiotherapy (RT) is a standard palliative treatment in clinical practice, and there is no effective clinical prediction model to predict the prognosis of PC patients receiving radiotherapy. This
study aimed to analyze PC\'s clinical characteristics, find the factors affecting PC patients\' prognosis, and construct a visual Nomogram to predict overall survival (OS).
SEER*Stat software was used to collect clinical data from the Surveillance, Epidemiology, and End Results (SEER) database of 3570 patients treated with RT. At the same time, the relevant clinical data of 115 patients were collected from the Affiliated Cancer Hospital of Zhengzhou University. The SEER database data were randomly divided into the training and internal validation cohorts in a 7:3 ratio, with all patients at The Affiliated Cancer Hospital of Zhengzhou University as the external validation cohort. The lasso regression was used to screen the relevant variables. All non-zero variables were included in the multivariate analysis. Multivariate Cox proportional risk regression analysis was used to determine the independent prognostic factors. The Kaplan-Meier(K-M) method was used to plot the survival curves for different treatments (surgery, RT, chemotherapy, and combination therapy) and calculate the median OS. The Nomogram was constructed to predict the survival rates at 1, 3, and 5 years, and the time-dependent receiver operating characteristic curves (ROC) were plotted with the calculated curves. Calculate the area under the curve (AUC), the Bootstrap method was used to plot the calibration curve, and the clinical efficacy of the prediction model was evaluated using decision curve analysis (DCA).
The median OS was 25.0, 18.0, 11.0, and 4.0 months in the surgery combined with chemoradiotherapy (SCRT), surgery combined with radiotherapy, chemoradiotherapy (CRT), and RT alone cohorts, respectively. Multivariate Cox regression analysis showed that age, N stage, M stage, chemotherapy, surgery, lymph node surgery, and Grade were independent prognostic factors for patients. Nomogram models were constructed to predict patients\' OS. 1-, 3-, and 5-year Time-dependent ROC curves were plotted, and AUC values were calculated. The results suggested that the AUCs were 0.77, 0.79, and 0.79 for the training cohort, 0.79, 0.82, and 0.81 for the internal validation cohort, and 0.73, 0.93, and 0.88 for the external validation cohort. The calibration curves Show that the model prediction probability is in high agreement with the actual observation probability, and the DCA curve shows a high net return.
SCRT significantly improves the OS of PC patients. We developed and validated a Nomogram to predict the OS of PC patients receiving RT.