目的:本研究旨在评估影响头颈部结节性黑色素瘤(NM)的危险因素与治疗方法之间的相关性,以及癌症特异性生存率(CSS),并为临床医师提供个性化的预测工具。
方法:从监测中提取1848例患者的回顾性研究数据,流行病学,和结束结果(SEER)数据库。使用Spearman方法将所有变量包括在相关性分析中。通过Cox风险回归分析提取并整合重要的预后因素,以构建列线图。为了评估列线图的性能,采用Harrell一致性指数(C指数)和受试者工作特征(ROC)曲线分析。
结果:Spearman\的相关分析显示放疗与淋巴结转移呈正相关,而化疗与远处转移的相关性更强。然而,Cox风险回归分析表明,Mohs手术和边缘超过1cm的广泛切除术具有实质性的治疗优势。五个独立的危险预后因素(Breslow厚度,溃疡,N分类,M分类,和手术类型)用于构建列线图。该列线图的C指数对于训练集为0.713,对于验证集为0.720。在训练集中,3-,5-,CSS和8年曲线下面积(AUC)分别为0.752、0.723和0.720,而验证集的AUC分别为0.754、0.763和0.760.校正曲线表明列线图对预测CSS具有很强的判别能力。
结论:在这项研究中,我们确定了头颈部NM患者的独立预后因素,并建立了一个相对准确的模型来预测他们的生存概率,这可能有助于肿瘤评估和临床决策。
方法:三级喉镜,2024.
OBJECTIVE: This study aims to evaluate the correlation between risk factors and treatment methods affecting nodular melanoma (NM) in the head and neck, as well as cancer-specific survival (CSS), and provide personalized predictive tools for clinical physicians.
METHODS: The retrospective study data of 1848 patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All variables were included in the correlation analysis using the Spearman method. Significant prognostic factors were extracted and integrated through Cox risk regression analysis to construct a nomogram. To assess the performance of the nomogram, Harrell\'s concordance index (C-index) and a receiver operating characteristic (ROC) curve analysis were employed.
RESULTS: Spearman\'s correlation analysis revealed a positive correlation between radiotherapy and lymph node metastasis, whereas chemotherapy showed a stronger association with distant metastasis. However, Cox risk regression analysis demonstrated that Mohs surgery and wide excision with margins exceeding 1 cm yielded substantial therapeutic advantages. Five independent risk prognostic factors (Breslow thickness, ulceration, N classification, M classification, and surgery type) were employed to construct a nomogram. The C-index for this nomogram was 0.713 for the training set and 0.720 for the validation set. In the training set, the 3-, 5-, and 8-year areas under the curve (AUCs) for CSS were 0.752, 0.723, and 0.720, whereas the validation set\'s AUCs were 0.754, 0.763, and 0.760, respectively. Calibration curves indicated the nomogram\'s strong discriminative ability for predicting CSS.
CONCLUSIONS: In this study, we identified independent prognostic factors for patients with NM in head and neck and developed a relatively accurate model to predict the survival probability of them, which could contribute to the tumor assessment and clinical decision-making.
METHODS: 3 Laryngoscope, 134:3611-3619, 2024.