Development and validation of a prognostic nomogram for predicting overall survival in patients with primary bladder sarcoma: a SEER-based retrospective study.
Development and validation of a prognostic nomogram for predicting overall survival in patients with primary bladder sarcoma: a SEER-based retrospective study.
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DOI：
10.1186/s12894-021-00929-x
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发表时间：
2021-11-25
期刊：
影响因子：
2
通讯作者：
Chen X
中科院分区：
文献类型：
--
作者：
Li S;Liu X;Chen X
原发性膀胱肉瘤是一种罕见的膀胱恶性肿瘤，预后差，其病程尚不清楚。因此，我们的研究旨在建立一个预测模型，以确定个性化的PBS患者的预后。从1973年至2015年登记的866例PBS患者的数据提取自监测，流行病学和最终结果（SEER）数据库。纳入的患者被随机分为训练组（n = 608）和验证组（n = 258）。单因素和多因素考克斯回归分析，以确定重要的独立预后因素。然后建立列线图以预测总生存期（OS）。使用校准曲线、受试者工作特征曲线、一致性指数（C指数）、决策曲线分析（DCA）、净重新分类改进（NRI）和综合鉴别改进（IDI），对诺模图的性能进行了内部验证。我们将列线图与TNM分期系统进行了比较。采用Kaplan-Meier生存分析对危险分层系统的应用进行了检验。诊断时的年龄、T分期、N分期、M分期和肿瘤大小被确定为OS的独立预测因素。训练队列的1年、3年和5年OS的C指数分别为0.675、0.670、0.671。验证队列的平均值分别为0.701、0.684、0.679。校准曲线也显示出很高的预测精度。与TNM分期系统相比，DCA、NRI和IDI的净效益均有所提高。危险分层系统能显著区分不同生存风险的患者。本研究开发并验证了预后列线图，以预测PBS患者的预后。它可以帮助临床医生评估患者的危险因素，并制定最佳的个性化治疗策略。在线版本包含补充材料，可通过10.1186/s12894-021-00929-x获得。
Primary bladder sarcoma (PBS) is a rare malignant tumor of the bladder with a poor prognosis, and its disease course is inadequately understood. Therefore, our study aimed to establish a prognostic model to determine individualized prognosis of patients with PBS. Data of 866 patients with PBS, registered from 1973 to 2015, were extracted from the surveillance, epidemiology, and end result (SEER) database. The patients included were randomly split into a training (n = 608) and a validation set (n = 258). Univariate and multivariate Cox regression analyses were employed to identify the important independent prognostic factors. A nomogram was then established to predict overall survival (OS). Using calibration curves, receiver operating characteristic curves, concordance index (C-index), decision curve analysis (DCA), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), the performance of the nomogram was internally validated. We compared the nomogram with the TNM staging system. The application of the risk stratification system was tested using Kaplan–Meier survival analysis. Age at diagnosis, T-stage, N-stage, M-stage, and tumor size were identified as independent predictors of OS. C-index of the training cohort were 0.675, 0.670, 0.671 for 1-, 3- and 5-year OS, respectively. And that in the validation cohort were 0.701, 0.684, 0.679, respectively. Calibration curves also showed great prediction accuracy. In comparison with TNM staging system, improved net benefits in DCA, evaluated NRI and IDI were obtained. The risk stratification system can significantly distinguish the patients with different survival risk. A prognostic nomogram was developed and validated in the present study to predict the prognosis of the PBS patients. It may assist clinicians in evaluating the risk factors of patients and formulating an optimal individualized treatment strategy. The online version contains supplementary material available at 10.1186/s12894-021-00929-x.
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