切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (04) : 274 -279. doi: 10.3877/cma.j.issn.2095-3232.2018.04.006

所属专题： 文献；

临床研究

基于阳性淋巴结数的进展期胆囊癌患者生存列线图预测模型
陈晨1, 刘德春1, 从龙龙1, 赵亚玲2, 张冠军3, 王林1, 耿智敏1,†()   
  1. 1. 710061　西安交通大学第一附属医院肝胆外科
    2. 710061　西安交通大医学院公共卫生系卫生统计教研室
    3. 710061　西安交通大学第一附属医院病理科
  • 收稿日期:2018-05-03 出版日期:2018-08-10
  • 通信作者: 耿智敏
  • 基金资助:
    国家自然科学基金(81572420)

Survival prognostic nomogram model based on the number of positive lymph nodes for patients with advanced gallbladder cancer

Chen Chen1, Dechun Liu1, Longlong Cong1, Yaling Zhao2, Guanjun Zhang3, Lin Wang1, Zhimin Geng1,†()   

  1. 1. Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
    2. Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an 710061, China
    3. Department of Pathology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
  • Received:2018-05-03 Published:2018-08-10
  • Corresponding author: Zhimin Geng
  • About author:
    Corresponding author: Geng Zhimin, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

陈晨, 刘德春, 从龙龙, 赵亚玲, 张冠军, 王林, 耿智敏. 基于阳性淋巴结数的进展期胆囊癌患者生存列线图预测模型[J]. 中华肝脏外科手术学电子杂志, 2018, 07(04): 274-279.

Chen Chen, Dechun Liu, Longlong Cong, Yaling Zhao, Guanjun Zhang, Lin Wang, Zhimin Geng. Survival prognostic nomogram model based on the number of positive lymph nodes for patients with advanced gallbladder cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(04): 274-279.

目的

探讨进展期胆囊癌根治性切除术后阳性淋巴结数在患者预后中的预测价值，构建生存列线图预测模型。

方法

回顾性分析2008年1月至2013年12月西安交通大学第一附属医院收治的158例进展期胆囊癌根治性切除患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男44例，女114例；平均年龄（61±11）岁。生存分析采用Kaplan-Meier生存曲线和Log-rank检验，采用Cox多因素分析筛选患者预后的影响因素，并建立术后预后列线图预测模型，采用一致性指数（C指数）评价模型。

结果

46.8%（74/158）患者出现淋巴转移，清扫淋巴结数中位数为6.5（1.0～22.0）个，阳性淋巴结数为1.5（0～12.0）个，淋巴结阳性率为25%（0～100%）。患者中位生存时间为29.0个月，1、3、5年累积生存率分别为62.0%、47.4%、42.8%。多因素分析显示T分期、切缘、病理分级及阳性淋巴结数为患者预后的独立影响因素（RR=2.446，2.694，1.897，2.892；P<0.05）。根据4个独立影响因素建立生存列线图预测模型，3、5年模型的C指数分别为0.797及0.794。

结论

阳性淋巴结数可应用于进展期胆囊癌患者的淋巴状态评估，指导患者生存预后分析。基于T分期、切缘、病理分级及阳性淋巴结数建立的列线图模型有助于对患者生存进行个体化预测。

关键词: 胆囊肿瘤, 淋巴结, 列线图, 预后
Objective

To explore the prognostic value of positive lymph node metastasis number in patients with advanced gallbladder cancer after radical resection and to establish a survival nomogram model for prediction.

Methods

Clinical data of 158 patients with advanced gallbladder cancer who underwent radical resection in the First Affiliated Hospital of Xi'an Jiaotong University from January 2008 to December 2013 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 44 males and 114 females, with an average age of (61±11) years. Survival analysis was performed using Kaplan-Meier survival curve and Log-rank test. The factors influencing the patients' prognosis were screened by Cox multivariate analysis. A nomogram model for the postoperative prognosis was established and was evaluated by consistency index (C-index).

Results

Lymph node metastasis was observed in 46.8%(74/158) of the patients. The median number of dissected lymph nodes was 6.5(1.0-22.0). There were 1.5(0-12.0) positive lymph nodes with a positive rate 25%(0-100%). The median survival time was 29.0 months. The 1-, 3-, 5-year accumulate survival rate was 62.0%, 47.4% and 42.8%, respectively. Multivariate analysis showed that the independent factors influencing the patients' prognosis were T staging, incisal margin, pathological grading and number of positive lymph nodes (RR=2.446, 2.694, 1.897, 2.892; P<0.05). A nomogram model for survival prediction was established based on the 4 independent factors, and the 3- and 5-year C-index was 0.797 and 0.794, respectively.

Conclusions

It can be used to evaluate the lymphatic status of patients with advanced gallbladder cancer and to assist the analysis of patient's survival through observing the positive lymph node metastasis. The survival nomogram model based on T staging, incisal margin, pathological grading and number of positive lymph node metastasis can help to make an individualized survival prediction for the patients.

Key words: Gallbladder neoplasms, Lymph nodes, Nomogram, Prognosis
表1 进展期胆囊癌根治性切除患者PLNC及LNR截点的选择
PLNC截点（个） χ2值 P值 LNR截点（%） χ2值 P值
0，1，>1 61.984 <0.05 0，1～10，>10 53.397 <0.05
0，1～2，>2 56.891 <0.05 0，1～20，>20 51.684 <0.05
0，1～3，>3 71.050 <0.05 0，1～30，>30 53.344 <0.05
0，1～4，>4 73.471 <0.05 0，1～40，>40 57.375 <0.05
0，1～5，>5 70.837 <0.05 0，1～50，>50 60.436 <0.05
0，1～6，>6 65.818 <0.05 0，1～60，>60 60.303 <0.05
0，1～7，>7 64.464 <0.05 0，1～70，>70 60.203 <0.05
? ? ? 0，1～80，>80 48.853 <0.05
表2 影响进展期胆囊癌根治性切除患者预后的Cox多因素分析
变量 多因素分析
RR P值 95%CI
T分期 ? ? ?
? T3 参照 ? ?
? T4 2.446 0.012 1.222～4.896
N分期 1.400 0.207 0.830～2.361
? N0 ? ? ?
? N1 ? ? ?
? N2 ? ? ?
切缘 ? ? ?
? R0 参照 ? ?
? R1 2.694 0.002 1.431～5.072
病理分级 1.897 0.001 1.286～2.798
? 高分化 ? ? ?
? 中分化 ? ? ?
? 低分化 ? ? ?
LNR（%） 0.867 1.043 0.634～1.716
? 0 ? ? ?
? 1～50 ? ? ?
? >50 ? ? ?
PLNC（个） 2.892 0.004 1.408～5.939
? 0 ? ? ?
? 1～4 ? ? ?
? >4 ? ? ?
图1 进展期胆囊癌患者根治性切除术后生存列线图预测模型
图2 列线图模型整体生存的校准图
[1]
Wistuba II, Gazdar AF. Gallbladder cancer: lessons from a rare tumour[J]. Nat Rev Cancer, 2004, 4(9):695-706.
[2]
赵坤，叶小鸣．2014年胆囊癌NCCN治疗指南解读与思考[J/CD]．中华肝脏外科手术学电子杂志, 2015, 4(2):76-78.
[3]
于勇，姜小清．胆囊癌的外科分期治疗[J/CD]．中华肝脏外科手术学电子杂志，2012,1(3):151-156.
[4]
Miyakawa S, Ishihara S, Horiguchi A, et al. Biliary tract cancer treatment: 5,584 results from the Biliary Tract Cancer Statistics Registry from 1998 to 2004 in Japan[J]. J Hepatobiliary Pancreat Surg, 2009, 16(1):1-7.
[5]
Fong Y, Wagman L, Gonen M, et al. Evidence-based gallbladder cancer staging: changing cancer staging by analysis of data from the National Cancer Database[J]. Ann Surg, 2006, 243(6):767-771.
[6]
Shirai Y, Wakai T, Hatakeyama K. Radical lymph node dissection for gallbladder cancer: indications and limitations[J]. Surg Oncol Clin N Am, 2007, 16(1):221-232.
[7]
Kondo S, Takada T, Miyazaki M, et al. Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment[J]. J Hepatobiliary Pancreat Surg, 2008, 15(1):41-54.
[8]
Birnbaum DJ, Vigano L, Russolillo N, et al. Lymph node metastases in patients undergoing surgery for a gallbladder cancer. extension of the lymph node dissection and prognostic value of the lymph node ratio[J]. Ann Surg Oncol, 2015, 22(3):811-818.
[9]
Negi SS, Singh A, Chaudhary A. Lymph nodal involvement as prognostic factor in gallbladder cancer: location, count or ratio?[J]. J Gastrointest Surg, 2011, 15(6):1017-1025.
[10]
Endo I, Shimada H, Tanabe M, et al. Prognostic significance of the number of positive lymph nodes in gallbladder cancer[J]. J Gastrointest Surg, 2006, 10(7):999-1007.
[11]
Young KA, Efiong E, Dove JT, et al. External validation of a survival nomogram for non-small cell lung cancer using the national cancer database[J]. Ann Surg Oncol, 2017, 24(6):1459-1464.
[12]
Wang SJ, Lemieux A, Kalpathy-Cramer J, et al. Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer[J]. J Clin Oncol, 2011, 29(35):4627-4632.
[13]
Bosman FT, World Health Organization, International Agency for Research on Cancer. WHO classification of tumours of the digestive system[M]. 4th ed. Lyon: International Agency for Research on Cancer, 2010:417.
[14]
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Ann Surg Oncol, 2010, 17(6):1471-1474.
[15]
Kiran RP, Pokala N, Dudrick SJ. Incidence pattern and survival for gallbladder cancer over three decades--an analysis of 10301 patients[J]. Ann Surg Oncol, 2007, 14(2):827-832.
[16]
Wild JR, Staton CA, Chapple K, et al. Neuropilins: expression and roles in the epithelium[J]. Int J Exp Pathol, 2012, 93(2):81-103.
[17]
Pawlik TM, Gleisner AL, Cameron JL, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer[J]. Surgery, 2007, 141(5):610-618.
[18]
Bando E, Yonemura Y, Taniguchi K, et al. Outcome of ratio of lymph node metastasis in gastric carcinoma[J]. Ann Surg Oncol, 2002, 9(8):775-784.
[19]
Shirai Y, Sakata J, Wakai T, et al. Assessment of lymph node status in gallbladder cancer: location, number, or ratio of positive nodes[J]. World J Surg Oncol, 2012(10):87.
[20]
Murakami Y, Uemura K, Sudo T, et al. Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma[J]. J Am Coll Surg, 2010, 211(2):196-204.
[21]
Lee JH, Lee KG, Ha TK, et al. Pattern analysis of lymph node metastasis and the prognostic importance of number of metastatic nodes in ampullary adenocarcinoma[J]. Am Surg, 2011, 77(3):322-329.
[22]
Freedman AN, Seminara D, Gail MH, et al. Cancer risk prediction models: a workshop on development, evaluation, and application[J]. J Natl Cancer Inst, 2005, 97(10):715-723.
[23]
Kim Y, Spolverato G, Ejaz A, et al. A nomogram to predict overall survival and disease-free survival after curative resection of gastric adenocarcinoma[J]. Ann Surg Oncol, 2015, 22(6):1828-1835.
[24]
Notake T, Kobayashi A, Shinkawa H, et al. Nomogram predicting long-term survival after the diagnosis of intrahepatic recurrence of hepatocellular carcinoma following an initial liver resection[J]. Int J Clin Oncol, 2017, 22(4):715-725.
[25]
Xu XL, Cheng H, Tang MS, et al. A novel nomogram based on LODDS to predict the prognosis of epithelial ovarian cancer[J]. Oncotarget, 2017, 8(5):8120-8130.
[26]
汤朝晖，田孝东，魏妙艳，等．美国癌症联合委员会胆道恶性肿瘤分期系统(第8版)更新解读[J]．中国实用外科杂志，2017,37(3):248-254.
[1] 邵华, 那子悦, 荆慧, 李博, 王秋程, 程文. 术前经皮超声造影对乳腺癌腋窝前哨淋巴结转移及负荷的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 849-853.
[2] 孙帼, 谢迎东, 徐超丽, 杨斌. 超声联合临床特征的列线图模型预测甲状腺乳头状癌淋巴结转移的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 734-742.
[3] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[4] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[5] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[6] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[7] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[8] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[9] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[10] 燕速, 霍博文, 徐惠宁. 4K荧光腹腔镜扩大右半结肠CME+D3根治术及No.206、No.204组淋巴结清扫术[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 14-14.
[11] 袁育韬, 邢金琳, 谢克飞, 殷凯. CT征象及BRAFV600E基因突变与甲状腺乳头状癌中央区淋巴结转移的相关性[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 611-614.
[12] 姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗：10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.
[13] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[14] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[15] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号