Development and validation of nomogram for prediction of malignant transformation in oral leukoplakia: A large-scale cohort study
Development and validation of nomogram for prediction of malignant transformation in oral leukoplakia: A large-scale cohort study
复制标题
用于预测口腔白斑恶变的列线图的开发和验证：一项大规模队列研究
DOI：
10.1111/jop.12862
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发表时间：
2019-07-01
影响因子：
3.3
通讯作者：
Guo, Chuan-Bin
中科院分区：
文献类型：
--
作者：
Wang, Tianjiao;Wang, Lin;Guo, Chuan-Bin
目的口腔白斑（OL）是一种众所周知的口腔粘膜疾病，有可能恶性并导致鳞状细胞癌（OSCC）。在接下来的研究中，我们根据临床病理变量的分析，开发了一个用于预测 OL 恶性进展的综合列线图。方法对1998年至2017年北京大学口腔医学院口腔医院诊断为OL的患者进行回顾性分析。 OL 通过治疗前活检确诊。使用Cox比例风险回归分析从临床病理变量中筛选OL恶变的候选危险因素。根据 COX 回归结果生成列线图模型，并通过 Harrell 一致性指数（c-index）和校准图进行验证 结果 OL 恶变（MT）发生率为 12.2%（107/875），平均随访时间为 4.5 年。来自 Cox 比例风险回归分析的危险因素（年龄、组织学分级、病变部位和吸烟习惯）被纳入用于预测 MT 严重程度的新型列线图模型中。列线图模型的c指数值为0.752，证实了预测能力；并通过校准图结果进一步证实。结论 我们的数据表明，年龄超过 50 岁的 OL 患者、不吸烟且有发育不良且 OL 病变累及唇、口底和舌的 OL 患者发生 MT 的风险较高。建立的列线图模型具有恶性进展的预测价值，有利于筛选高危患者并指导治疗策略。
Purpose Oral leukoplakia (OL) is the well-known disorder of oral mucosa, which has potential to be malignant and can lead to squamous cell carcinoma (OSCC). In the following study, we developed a comprehensive nomogram for predicting the malignant progression of OL, based on analysis of clinicopathological variables. Methods A retrospective analysis of patients diagnosed with OL was performed between 1998 and 2017 at the Peking University School and Hospital of Stomatology. OL was confirmed by pre-treatment biopsy. The candidate risk factors for OL malignant transformation were screened from clinicopathological variables using the Cox proportional hazard regression analysis. The nomogram model was generated based on the COX regression results and was validated through Harrell concordance index (c-index) and calibration plots Results The incidence of OL malignant transformation (MT) was 12.2% (107/875), and the mean follow-up time was 4.5 years. The risk factors (age, histologic grade, site of lesion and smoking habit) derived from Cox proportional hazard regression analysis were incorporated in a novel nomogram model for prediction of MT severity. The c-index value of the nomogram model was 0.752, which confirmed the prediction ability; and was further confirmed by calibration plots results. Conclusion Our data suggest that patients with OL who are over 50 years old, non-smokers with dysplasia, and OL lesions involving the lip, the floor of mouth, and tongue have an enhanced risk of MT. The established nomogram model has the predictive value of malignant progression, which is conductive to screen high-risk patients and guide treatment strategy.