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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:
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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/OL]. 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/OL]. 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
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