發(fā)布時間：2018-07-05 04:21

  本文選題：食管癌 + 腫瘤長度��； 參考：《浙江大學(xué)》2015年博士論文

【摘要】：目的： 食管鱗狀細(xì)胞癌腫瘤長度對預(yù)后的影響一直存在爭議。本研究旨在探討食管鱗狀細(xì)胞癌腫瘤病理長度的預(yù)測和預(yù)后意義。并且選擇理想的腫瘤長度臨界值以獲得準(zhǔn)確的風(fēng)險分層。 方法： 自2003年1月至2010年12月,1613例食管癌患者在我科行手術(shù)治療�；颊吲R床病理資料均從電子病歷系統(tǒng)收集。利用Cox風(fēng)險比例回歸模型鞅殘差(Martingale Residuals)分析獲取腫瘤病理長度最佳臨界值。探討腫瘤病理長度對預(yù)后的影響及其與其他臨床病理因素之間的相關(guān)性。利用基于赤池信息標(biāo)準(zhǔn)(Akaike Information Criterion, AIC)的Cox回歸模型篩選臨床病理變量以確立獨立預(yù)后因子。各臨床病理變量的預(yù)后預(yù)測準(zhǔn)確度以Harrell一致性指數(shù)為指標(biāo)(Harrell Concordance Index,C-index).建立數(shù)個Cox回歸模型以評價臨床病理變量與預(yù)后的關(guān)系。各模型采用自助重抽樣法(bootstrap)作內(nèi)部驗證,行校準(zhǔn)(validation)和鑒別(discrimination),并將模型以列線圖(nomogram)方式表示以預(yù)測預(yù)后。時間依賴性接受者工作特征(time-dependent Receiver Operating Characteristic, time-dependentROC)也用于評價各模型的預(yù)測準(zhǔn)確性。對于腫瘤病理長度是否增加TNM分期模型的預(yù)后準(zhǔn)確性,使用生存資料的凈重分類改善指數(shù)(Net Reclassification improvement, NRI)和整體鑒別指數(shù)(Integrated Discrimination Index, IDI)分析。 結(jié)果： 根據(jù)納入標(biāo)準(zhǔn),選擇1435例經(jīng)行根治術(shù)的食管鱗狀細(xì)胞癌患者行回顧性分析。鞅殘差分析顯示腫瘤病理長度最佳臨界值為4厘米。腫瘤病理長度與年齡、性別、腫瘤部位、T分期、N分期、以及切除淋巴結(jié)數(shù)目相關(guān)。腫瘤病理長度型厘米患者預(yù)后優(yōu)于腫瘤病理長度4厘米患者(中位生存期,48月vs27月P0.001)。腫瘤分化程度、年齡、T分期、N分期、切除淋巴結(jié)數(shù)目、以及病理長度是食管鱗癌獨立預(yù)后因子。腫瘤病理長度(C-index=58.1%)的預(yù)后準(zhǔn)確性略低于N分期(C-index=67.1%)和T分期(C-index=60.5%)。在預(yù)測5年生存率方面,TNM分期模型預(yù)測準(zhǔn)確度略小于TNM分期聯(lián)合腫瘤病理長度模型(69.4%vs69.8%,P0.001)。各模型的校準(zhǔn)圖顯示預(yù)測結(jié)果與實際結(jié)果一致性良好。類似結(jié)果也出現(xiàn)在時間依賴性接受者工作特征分析中。比較TNM分期模型與TNM分期加腫瘤病理長度模型,腫瘤病理長度未顯示其能提高TNM分期預(yù)測準(zhǔn)確性(NRI=0.001,P=0.637; IDI=0.046, P=0.498)。 結(jié)論： 腫瘤病理長度是食管鱗狀細(xì)胞癌的獨立預(yù)后因子。其最佳臨界值為4厘米。但腫瘤病理長度并不提高現(xiàn)行TNM分期的預(yù)測準(zhǔn)確性。
[Abstract]:Objective: the effect of tumor length on prognosis of esophageal squamous cell carcinoma has been controversial. The purpose of this study was to investigate the prognostic significance of pathological length of esophageal squamous cell carcinoma (ESCC). And select the ideal critical value of tumor length to obtain accurate risk stratification. Methods: from January 2003 to December 2010, 1613 patients with esophageal cancer underwent surgical treatment in our department. The clinical and pathological data of the patients were collected from the electronic medical record system. Martingale residuals (Martingale residuals) analysis was used to obtain the best critical value of pathological length of tumor. To investigate the influence of tumor pathological length on prognosis and its correlation with other clinicopathological factors. A Cox regression model based on Akaike Information criteria was used to screen clinicopathological variables to establish independent prognostic factors. The prognostic accuracy of all clinicopathological variables was determined by Harrell concordance index (Harrell concordance index). Several Cox regression models were established to evaluate the relationship between clinicopathologic variables and prognosis. The models were verified by self-help resampling method (bootstrap). The (validation) was calibrated and the (discrimination), was identified. The models were expressed as (nomogram) to predict the prognosis. Time-dependent receiver operating characteristic (time-dependent ROC) is also used to evaluate the prediction accuracy of each model. As to whether the pathological length of tumor increases the prognostic accuracy of TNM staging model, the net weight classification improvement index (NRI) and Integrated Discrimination Index (IDI) of survival data were used. Results: according to the inclusion criteria, 1435 patients with esophageal squamous cell carcinoma undergoing radical resection were retrospectively analyzed. Martingale residual analysis showed that the optimal critical value of pathological length was 4 cm. The pathological length of tumor was correlated with age, sex, T stage and N stage of tumor site, and the number of lymph nodes resected. The prognosis of patients with pathological length of tumor was better than that of patients with tumor length of 4 cm (median survival time, 48 months vs27 month, P0. 001). Tumor differentiation, age T stage and N stage, number of resected lymph nodes, and pathological length were independent prognostic factors of esophageal squamous cell carcinoma. The prognostic accuracy of tumor pathological length (58.1%) was slightly lower than that of N stage (67.1%) and T stage (60.5%). The prediction accuracy of TNM staging model was slightly less than that of TNM staging combined with tumor pathological length model (69.4 vs 69.8 / P0.001). The calibration diagrams of each model show that the predicted results are in good agreement with the actual results. Similar results were found in the analysis of work characteristics of time dependent recipients. Compared with TNM staging model and TNM staging plus tumor pathological length model, the tumor pathological length did not improve the accuracy of TNM staging (NRI0. 001, P0. 637, IDI 0. 046, P0. 498). Conclusion: tumor pathological length is an independent prognostic factor for esophageal squamous cell carcinoma. The optimum critical value is 4 cm. However, tumor pathological length does not improve the prediction accuracy of TNM staging.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R735.1

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相關(guān)期刊論文 前1條

1 余紅梅,何大衛(wèi),徐勇勇;鞅殘差在Cox回歸模型診斷中的應(yīng)用[J];現(xiàn)代預(yù)防醫(yī)學(xué);2001年01期

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本文編號：2098903