基于SEER数据库的原发性肝癌患者预后危险因素研究

Study on prognostic risk factors of patients with primary liver cancer based on SEER database

摘要:

目的 探讨原发性肝癌患者预后的危险因素，为该病患者的临床诊疗和预后判断提供科学依据。方法 以2018年监测、流行病学和结果（Surveillance，Epidemiology，and End Results，SEER）数据库原发性肝癌患者作为研究对象，收集人口学资料、临床指标和预后随访信息，运用单因素和多因素logistic回归分析影响患者术后生存的危险因素。采用一致性指数评价模型的预测能力，构建受试者工作特征曲线分析预测模型的效能。采用绘制森林图的方法对不同分期下肝癌患者的治疗方式进行分析。结果 该研究共收集2018年原发性肝癌患者1 750例。单因素logistic回归结果表明，肿瘤分期、淋巴结转移、远处转移、婚姻状况、放化疗及手术是影响原发性肝癌患者生存的危险因素（P<0.05）；多因素logistic回归分析结果表明，肿瘤分期[T2/T3相对于T1，OR=5.142/3.390，95%CI=（3.654~7.236）/（2.327~4.939），P<0.001]、远处转移（OR=4.810，95%CI=3.384~6.839，P<0.001）、婚姻状况（OR=0.729，95%CI=0.575~0.925，P=0.009）、放疗（OR=0.361，95%CI=0.260~0.503，P<0.001）、化疗（OR=0.512，95%CI=0.381~0.687，P=0.001）以及手术（OR=0.245，95%CI=0.105~0.574，P=0.028）是影响肝癌患者生存的危险因素。将logistic回归中有意义的变量如肿瘤分期、远处转移、婚姻状况、放化疗和手术情况进行预测模型的构建，研究显示该模型一致性指数为0.786（95%CI=0.762~0.810），曲线下面积（area under the curve，AUC）为0.790（95%CI=0.764~0.812）。仅放疗这种干预方式在任何肿瘤分期的患者中都展现出了优势（P=0.003、P=0.013、P=0.003）。在未发生淋巴结转移的患者中无论哪种干预方式都会降低肝癌患者的病死率（P<0.001，P=0.001，P<0.001，P=0.004），但是在发生淋巴结转移的患者中，是否进行干预对肝癌患者的生存没有影响（P>0.05）。在未发生远处转移的患者中，仅进行放疗、化疗或化疗+放疗干预方式的患者与未进行干预的患者相比生存率更高（P<0.001，P=0.001，P<0.001，P=0.004），在发生远处转移的患者中，仅进行放疗的干预方式展现出优势（P=0.002）。结论 肿瘤分期、远处转移、婚姻状况、放化疗和手术情况是影响原发性肝癌预后的危险因素。

Abstract:

Objective To explore the prognostic risk factors of patients with primary liver cancer， so as to provide a scientific basis for the clinical diagnosis，treatment and prognosis of the patients with this disease.Methods The patients with primary liver cancer from the 2018 Surveillance，Epidemiology and End Results（SEER） database were served as the research subjects， the demographic data， clinical indicators and prognostic follow-up information were collected，and the risk factors affecting postoperative survival were analyzed by using the univariate and multivariate logistic regression. The consistency index was used to evaluate the prediction ability of the model，and the performance of the prediction model was analyzed by constructing the receiver operating characteristic（ROC） curve. The forest map was used to analyze the treatment methods of liver cancer patients at different stages.Results A total of 1 750 patients with primary liver cancer in 2018 were collected in the study. The univariate logistic regression results showed that the tumor staging，lymph node metastasis，distant metastasis，marital status，radiochemotherapy and surgery were the risk factors affecting the survival of the patients with primary liver cancer（P<0.05）；the multivariate Logistic regression analysis results showed that the tumor staging [T2/T3 relative to T1，OR=5.142/3.390，95%CI=（3.654-7.236）/（2.327-4.939），P<0.001]，distant metastasis（OR=4.810， 95%CI=3.384-6.839，P<0.001），marital status（0.729，95%CI=0.575-0.925，P=0.009），radiotherapy（OR=0.361，95%CI=0.260-0.503，P<0.001），chemotherapy（OR=0.512，95%CI=0.381-0.687，P=0.001） and surgery（OR=0.245，95%CI=0.105-0.574，P=0.028） were the risk factors affecting the survival of the patients with liver cancer. The significant variables in logistic regression were used to conduct the construction of the prediction model. The study showed that the concordance index of the model was 0.786 （95%CI=0.762-0.810），and the area under the curve（AUC） of the model was 0.790（95%CI=0.764-0.812）. The interventional means of radiotherapy alone showed an advantage in the patients with any tumor staging（P=0.003，P=0.013，P=0.003）. In the patients without lymph node metastasis，no matter which intervention means would reduce the mortality of the patients with liver cancer（P<0.001，P=0.001，P<0.001，P=0.004），but in the patients with lymph node metastasis， whether conducting intervention had no effect on the survival of the patients with liver cancer（P>0.05）. Among the patients without distant metastasis，the survival rate of the patients with only radiotherapy，only chemotherapy and chemotherapy + radiotherapy intervention was higher than that of the patients without intervention（P<0.001，P=0.001，P<0.001，P=0.004）. Among the patients with distant metastasis，only the interventional means of radiotherapy showed the advantage（P=0.002）.Conclusion The tumor staging，distant metastasis，marital status， radiochemotherapy and surgery are the risk factors affecting the prognosis of primary liver cancer.