胃神经内分泌肿瘤预后的相关因素及评分系统的构建
Related factors of gastric neuroendocrine tumor prognosis and construction of the scoring system

摘要：目的 分析胃神经内分泌肿瘤预后的相关因素，构建可视化评分系统。方法 提取SEER数据库2004年至2012年有完整随访资料的胃神经内分泌肿瘤患者的临床数据进行统计分析，绘制Kaplan-Meier生存曲线，采用Log-rank检验进行单因素分析，COX回归进行多因素分析，并用nomogram进行COX回归评分系统的可视化构建。结果 单因素分析显示，性别、年龄、婚姻状况、人种、是否多发、肿瘤分级、TNM分期、肿瘤部位、组织学类型、是否手术是影响胃神经内分泌肿瘤患者预后的危险因素。多因素COX回归分析显示，性别、年龄、婚姻状况、人种、是否多发、肿瘤分级、N分期、M分期、是否手术是影响胃神经内分泌肿瘤患者预后的独立危险因素。预测模型3、5、10年的预测价值均明显高于第6版AJCC TNM分期系统的预后价值，差异有统计学意义(3年：Z=13.178，P<0.0001；5年：Z=11.462，P<0.0001；10年：Z=4.298，P<0.0001)。结论 影响胃神经内分泌肿瘤预后的相关因素较多；本研究绘制的可视化nomogram可根据患者的评分计算出患者的3、5、10年生存率，且预测价值明显优于TNM分期系统，对临床工作具有重要的指导意义。
ABSTRACT: Objective To analyze the prognostic factors of gastric neuroendocrine tumors and construct a visual scoring system. Methods The clinical data of patients with gastric neuroendocrine tumors with complete follow-up data from 2004 to 2012 in the SEER database were analyzed. Kaplan-Miere survival curves were plotted, Log-rank test was used for single factor analysis, COX regression was used for multivariate analysis, and nomogram was used to visualize the COX regression scoring system. Results Univariate analysis showed that gender, age, marital status, ethnicity, being multiple, tumor grade, TNM stage, tumor location, histological type, and surgery were risk factors affecting the prognosis of patients with gastric neuroendocrine tumors. Multivariate COX regression analysis showed that gender, age, marital status, ethnicity, being multiple, tumor grade, N stage, M stage, and surgery were independent risk factors affecting the prognosis of patients with gastric neuroendocrine tumors. The predictive value of the 3, 5, and 10-year of prediction models was significantly higher than the prognostic value of the sixth edition of the AJCC TNM staging system, with significant difference (3-year: Z=13.178, P<0.0001; 5-year: Z=11.462, P<0.0001; 10-year: Z=4.298, P<0.0001). Conclusion Many related factors affect the prognosis of gastric neuroendocrine tumors. The visual nomogram drawn in this study can calculate the patient’s 3-year, 5-year and 10-year survival rate according to the patient’s score. The predictive value is obviously superior to that of the TNM staging system, which has important guiding significance for clinical work