【摘要】 目的旨在开发预后列线图来预测四肢骨肉瘤患者的生存率。方法回顾分析 1995 年至 2014 年,1910 例四肢骨肉瘤患者 (来自 SEER 数据库),通过单因素 Log-rank 分析和多因素 COX 分析找出存在统计学差异的预后因素,使用相应的预后因素构建列线图,进而对患者 1、3、5 年的总生存期 (overall survival,OS) 和癌症特异性生存期 (cancer-specific survival,CSS) 进行预测。然后对列线图进行内外部验证,并且通过使用 C 指数为量化指标来计算模型的准确性。结果单因素和多因素分析显示肿瘤确诊年龄、分期、手术状态、大小和病理类型与患者的 OS 和 CSS 显著相关。基于这些预后指标,构建能够预测患者的 1、3、5 年 OS 和 CSS 的列线图。对该列线图进行内外部验证,发现该列线图均具有较好的 C 指数,其中在内部验证中,OS 为 0.721,CSS 为 0.712;外部验证中,OS 为 0.681,CSS 为 0.683。在内外部验证中,列线图的校准图显示了骨肉瘤患者的实际存活率和该列线图预测结果之间有着良好的一致性。结论骨肉瘤确诊年龄、分期、手术状态、大小和病理类型与患者的 OS 和 CSS 显著相关。四肢骨肿瘤患者 OS 和 CSS 的列线图,可较为准确地估计四肢骨肉瘤患者 1、3、5 年的 OS 和 CSS,进而帮助临床医生更快、更可靠的做出临床预测。更多还原

【Abstract】 Objective To develop prognostic nomograms to predict the survival rate of patients with extremity osteosarcoma.Methods The study,which retrospectively analyzed 1910 extremity osteosarcoma patients (SEER database) from 1995 to 2014,used univariate Log-rank analysis and multivariate COX analysis to find independent prognostic factors.Nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of patients at 1,3,and 5 years were constructed using the prognostic factors.Internal and external verification of the nomograms were performed.The accuracy of the models was calculated by the C-index as a quantitative index.Results Univariate and multivariate analysis showed that age,stage,surgical status,size,and pathological type of the tumor were significantly correlated with OS and CSS.Based on these prognostic indicators,nomograms which could predict the 1,3,and 5 years’ OS and CSS were constructed.The internal and external verification of the nomograms were found to have a good C-index.In the internal verification,the C-index of OS was 0.721 and of CSS was 0.712.In the external verification,the C-index of OS and CSS were 0.681 and 0.683.In internal and external validation,the calibration plots showed a good agreement between the actual survival rate of osteosarcoma patients and the prediction results of the nomograms.Conclusions The age,stage,surgical status,size,and pathological type of osteosarcoma are significantly related to the OS and CSS.Nomograms can estimate the 1,3,and 5 years’ OS and CSS in patients with extremity osteosarcoma,which can help clinicians make more reliable clinical predictions.更多还原