子宫内膜癌预后因素的Cox回归分析

目的:探讨影响子宫内膜癌预后的相关危险因素。方法:回顾分析110例子宫内膜癌患者临床资料,对年龄、子宫内膜家族史、手术-病理分期、病理类型、组织学分级、淋巴结转移、治疗方式等因素进行单因素和多因素分析。采用 Kaplan-Meier法计算生存率,Log-rank检验进行单因素分析及各组生存率曲线分布比较,Cox回归模型进行多因素分析。结果:110例子宫内膜癌患者的生存时间为2-133个月,中位生存时间52.4个月,因子宫内膜癌死亡者24例(21.8%)。1、3、5年总体生存率分别为95.4%、85.5%、78.2%。单因素分析表明:不同病理类型、手术-病理分期、肿瘤大小、淋巴结转移、组织学分级、治疗方式的生存率差异有统计学意义（P＜0.05）。Cox风险比例回归模型进行多因素分析结果显示病理类型、手术-病理分期、组织学分级、淋巴结转移、治疗方式是影响子宫内膜癌预后的独立因素。结论:病理类型、手术-病理分期、组织学分级、淋巴结转移、治疗方式是影响子宫内膜癌预后的独立因素。     

胃癌合并腹水患者预后因素的Cox回归分析

目的 探讨影响胃癌合并腹水患者生存的预后因素。方法 回顾性分析2011年10月至2013年10月于本院住院治疗且随访资料完整的58例晚期胃癌合并腹水患者的病例资料,采用Kaplan-Meier法进行生存分析,Log-rank法进行单因素分析,Cox比例风险模型进行多因素分析。结果 58例胃癌合并腹水患者的中位生存期为14.0月。单因素分析显示分化程度、浸润深度、肝脏转移情况、KPS评分和治疗方法 与患者预后有关,而性别、年龄和腹水量则与预后无关。经Cox多因素回归分析,分化程度、浸润深度、肝脏转移情况、KPS评分及治疗方法 是影响胃癌合并腹水患者预后的独立危险因素。结论 分化程度、浸润深度、肝脏转移情况、KPS评分及治疗方法 是影响胃癌合并腹水患者预后的强相关因素,可作为独立预后指标指导胃癌合并腹水患者的治疗。     

肺鳞癌预后的Cox回归研究

目的 综合分析影响肺鳞癌预后的临床及社会心理等各种因素，建立肺鳞癌患者的预后指数（ＰＩ）模型，为临床上选择治疗方案、判断患者的预后及开展社会心理健康教育提供参考。方法 对３０８例肺鳞癌患者进行全程随访，运用Ｃｏｘ回归模型对各种预后因素进行分析。结果 从６９项预后因素中确定病后情绪、初治时手术方式、病后饮食情况、初治时合并其它疾病、社会支持、初治时单纯放疗方式及复治次数７项为影响肺鳞癌预后的主要因素     

支架置入术后晚期食管癌患者预后影响因素的Cox回归分析

背景与目的：支架置入术治疗晚期食管癌的预后受多种因素影响,哪些是主要因素,目前尚不明了。本文分析影响食管支架置入术治疗晚期食管癌患者的预后因素,探索晚期食管癌姑息治疗的合理方案。方法：对1997-2001年连续收治符合入组条件的、经支架置入术治疗的晚期食管癌患者102例,以性别、年龄、肿瘤部位、肿瘤长度、食管狭窄程度、肿瘤病理类型、肿瘤细胞分化程度、临床分期（T、N、M）、术前治疗、术后治疗（放疗和/或化疗）等12个因素作为分析因子,应用Cox回归模型分析影响预后的因素,应用寿命表法计算生存率。结果：全组支架置入成功率98.3％。所有患者吞咽功能明显改善（P=0.000）、生活质量评分（KPS评分）明显提高（P=0.000）,并发症发生率43.1％（44/102）。术后3、6、9、12个月生存率分别是67.53％、40.59％、27.43％、18.65％。Cox回归分析结果：影响预后有统计学意义的因子是原发肿瘤浸润程度（P=0.0410）和远处转移情况（P=0.006）,两者的OR值分别为1.750（95％CI,0.996-3.074）和1.527（95％CI,1.126-2.069）,支架置入术后放疗或/和化疗对生存期的影响无统计学意义。结论：影响支架置入术后患者生存期的因素,主要是原发肿瘤的浸润情况及远处转移情况;支架置入术后进一步放疗和/或化疗不能延长患者生存期。     

Cox模型在肿瘤预后因素分析中的应用

在肿瘤疗效评价和预后因素分析中,常应用生存分析方法,而Cox模型是目前国外最受欢迎的多因素分析方法,随着计算机使用的日益推广,国内也已开始应用Cox模型。 一、Cox模型在生存分析中的重要地位 生存分析最早的方法是寿命表法,在三百多年前它就被用于人寿保险方面,而后广泛地用于居民健康水平统计和疾病预后分析。本世纪四十年代,由于工     

145例宫颈癌病人的疗效及预后因素的Cox模型分析

本文应用寿命表法计算累积生存率,结果145例宫颈癌病人的5年生存率为61％.采用Cox模型对资料完整的115例病人的可疑影响因素进行多因素分析,从22项因素中筛选出5个对预后影响显著的因素(P<0.01).它们是临床分期、病理类型、术前化疗、淋巴结转移和术前放疗.其中,临床分期是对病人生存时间影响最为重要的因素,其次是淋巴结转移.根据每位病人的特征,对106例随访满5年的病人计算预测值,对预后进行预测,结果符合率和灵敏度分别为86.79％和85.48％.     

No期食管鳞癌根治术后预后因素的Cox回归分析

目的：探讨No期食管鳞癌术后生存率的影响因素。方法：选择10个可能对术后预后产生影响的研究因素，通过Cox比例风险模型进行多因素分析，对我院1998年8月～2001年8月间的98例No期食管鳞癌术后患者预后进行研究。结果：全组1、3、5年生存率分别为95．92％、85．71％、81．63％。结论：Cox多因素分析显示，影响预后的独立因素是肿瘤浸润深度（T分期），肿瘤分化分级。     

肛管癌预后的Cox回归分析

目的对36例肛管癌患者进行生存分析,找出影响其预后的分子生物学及临床因子,探讨提高疗效的措施。方法应用免疫组化S-P法检测36例肛管癌标本中P33ING1的表达,用Log-rank检验及Cox回归分析其可能影响预后的11个因子。结果多因素分析显示,肿瘤淋巴结转移、手术方式、放疗、P33ING1表达等是影响其预后的分子生物学及临床因子。结论P33ING1低表达是预后差的生物学因子,增加P33ING1的表达是治疗肛管癌的新途径。早发现、早治疗是提高肛管癌5年生存率的关键。     

结直肠癌临床病理参数预后意义的多因素Cox回归分析

回顾性分析了自１９８０～１９８９年来接受手术治疗的７４２例大肠腺癌病例。通过对临床病理指标的单因素和多因素Ｃｏｘ回归分析，研究影响大肠癌患者预后的独立性因素。研究结果表明：淋巴结受累（β＝０．４９８２，Ｐ＜０．０００１）及肠壁浸润深度（β＝０．１２６５，Ｐ＜０．０３１２）是影响大肠癌预后的独立性指标。由此提示：Ｄｕｋｅｓ′分期（β＝０．６３３４，Ｐ＜０．０００１）是一项独立的预后指标，亦是判断大肠癌患者临床结局的最重要和最准确的依据。     

A comparison of all-subset Cox and accelerated failure time models with Cox step-wise regression for node-positive breast cancer

Summary Clinical studies usually employ Cox step-wise regression for multivariate investigations of prognostic factors. However, commercial packages now allow the consideration of accelerated failure time models (exponential, Weibull, log logistic, and log normal), if the underlying Cox assumption of proportional hazards is inappropriate. All-subset regressions are feasible for all these models.We studied a group of 378 node positive primary breast cancer patients accrued at the Henrietta Banting Breast Centre of Women's College Hospital, University of Toronto, between January 1, 1977, and December 31, 1986. 85% of these patients had complete prognostic factor data for multivariate analysis, and 96% of the patients were followed to 1990. There was evidence of marked departures from the proportional hazards assumption with two prognostic factors, number of positive nodes and adjuvant systemic therapy. The data strongly supported the log normal model. The all-subset regressions indicated that three models were similarly good. The variables 1) number of positive nodes, 2) tumour size, and 3) adjuvant systemic therapy were included in all three models along with one of three biochemical receptor variables 1) ER, 2) combined receptor (ER- PgR-; ER+ PgR-; ER- PgR+; ER+ PgR+; or 3) PgR.Better multivariate modeling was achieved by using quantitative prognostic factors, a check for appropriate underlying model-type, and all-subset variable selection. All-subset regressions should be considered for routine use with the many new prognostic factors currently under evaluation; it is very possible that there may not be a single model that is substantially better than others with the same number of variables.     

A prognostic model for ovarian cancer

About 6000 women in the United Kingdom develop ovarian cancer each year and about two-thirds of the women will die from the disease. Establishing the prognosis of a woman with ovarian cancer is an important part of her evaluation and treatment. Prognostic models and indices in ovarian cancer should be developed using large databases and, ideally, with complete information on both prognostic indicators and long-term outcome. We developed a prognostic model using Cox regression and multiple imputation from 1189 primary cases of epithelial ovarian cancer (with median follow-up of 4.6 years). We found that the significant (P< or = 0.05) prognostic factors for overall survival were age at diagnosis, FIGO stage, grade of tumour, histology (mixed mesodermal, clear cell and endometrioid versus serous papillary), the presence or absence of ascites, albumin, alkaline phosphatase, performance status on the ZUBROD-ECOG-WHO scale, and debulking of the tumour. This model is consistent with other models in the ovarian cancer literature; it has better predictive ability and, after simplification and validation, could be used in clinical practice.     

Survival of patients with nonseminomatous germ cell cancer: a review of the IGCC classification by Cox regression and recursive partitioning

The International Germ Cell Consensus (IGCC) classification identifies good, intermediate and poor prognosis groups among patients with metastatic nonseminomatous germ cell tumours (NSGCT). It uses the risk factors primary site, presence of nonpulmonary visceral metastases and tumour markers alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG) and lactic dehydrogenase (LDH). The IGCC classification is easy to use and remember, but lacks flexibility. We aimed to examine the extent of any loss in discrimination within the IGCC classification in comparison with alternative modelling by formal weighing of the risk factors. We analysed survival of 3048 NSGCT patients with Cox regression and recursive partitioning for alternative classifications. Good, intermediate and poor prognosis groups were based on predicted 5-year survival. Classifications were further refined by subgrouping within the poor prognosis group. Performance was measured primarily by a bootstrap corrected c-statistic to indicate discriminative ability for future patients. The weights of the risk factors in the alternative classifications differed slightly from the implicit weights in the IGCC classification. Discriminative ability, however, did not increase clearly (IGCC classification, c=0.732; Cox classification, c=0.730; Recursive partitioning classification, c=0.709). Three subgroups could be identified within the poor prognosis groups, resulting in classifications with five prognostic groups and slightly better discriminative ability (c=0.740). In conclusion, the IGCC classification in three prognostic groups is largely supported by Cox regression and recursive partitioning. Cox regression was the most promising tool to define a more refined classification.British Journal of Cancer (2004) 90, 1176-1183. doi:10.1038/sj.bjc.6601665 www.bjcancer.com Published online 24 February 2004     

Cox multivariate regression analysis of recurrence factors for colonic carcinoma

Colonic carcinoma is one of the most commonmalignant tumor. There has been limited improvement insurvival following curative surgery over the previousthree decades, with local recurrence of the disease, withor without disseminated disease, remaining a particularproblem. Analysis of prognostic factors of coloniccarcinoma is helpful in identifying the people with a highrisk of postoperative recurrence. Thus individual therapyas well as comprehensive therapy can be applied. In thispaper, Cox mul…     

老年结肠癌根治术后复发转移Cox模型回归分析

目的收集并分析2002年1月-2013年6月11年问209例行结肠癌根治术的老年患者的病理特征和手术情况,探讨影响术后复发转移的因素。方法采用Cox风险比例模型对患者的年龄、性别、病程、住院时长、手术医生经验、手术时长、是否为腹腔镜手术、肿瘤部位、肿瘤大小、肿瘤大体形态、分化程度、浸润深度、淋巴结转移和梗阻共计14个变量进行单因素和多因素分析,运用Kaplan—Meier法绘制患者术后复发转移生存曲线。结果单因素分析发现,肿瘤大小（RR：2．658,P〈0．0001）、大体形态（浸润型RR=3．407,P=0．0054）、分化程度（RR=0．32,P〈0．0001）与结肠癌根治术后复发转移有关,多因素分析结果显示,患者性别（RR=0．585,P=0．0359）、肿瘤大小（RR=2．364,P〈0．0001）、大体形态（浸润型RR=0．246,P=0．0437）、分化程度（RR=0．31,P〈0．0001）与结肠癌根治术后复发转移有关。结论患者性别、肿瘤大小、大体形态和分化程度是影响老年结肠癌根治术后复发转移的因素,对确定高危人群,进行有针对性的术后随访,提早发现和治疗有重要意义,有利于提高患者生活质量,延长患者生存时间,     

COX模型在妇瘤中的应用

目的　通过多因素回归方式有效地探讨了抑癌基因 ,DNA以及AgNOR等分子指标对卵巢癌预后的影响。方法　应用PCR技术 ,免疫组化 ,图象分析和COX模型等先进手段进行分子基因水平的研究。我们对 10 0例卵巢组织标本包括 6 0例卵巢癌 ,2 0例卵巢良性肿瘤 ,2 0例正常卵巢组织进行联合检测。结果　通过COX多因素比例风险模型了解到抑癌基因P5 3AGNOR含量DNA倍体水平与卵巢癌预后密切相关。其中AGNOR含量为最相关因素。结论　COX模型为妇科肿瘤预后的筛选 ,提供了重要参数。     

晚期十二指肠癌患者一线化疗的临床疗效及预后因素分析

目的 探讨晚期十二指肠癌患者一线化疗方案的疗效与安全性以及影响预后的因素。方法 回顾分析本院2008年6月至2016年1月收治的晚期十二指肠癌患者40例,9例未接受化疗,31例接受化疗,其中GEMOX方案13例、FOLFOX方案13例、卡培他滨单药2例和吉西他滨单药3例。采用RECIST 1.1版与NCI CTC 4.0版标准评价化疗的近期疗效和不良反应。生存分析采用Kaplan Meier法并行Log rank检验,多因素分析采用Cox比例风险回归模型。结果 31例化疗患者均可评价疗效和不良反应,共完成化疗146个周期,中位化疗4个周期（2～12个周期）。GEMOX方案组获PR 1例、SD 10例、PD 2例,疾病控制率（DCR）为84.6％;FOLFOX方案组获SD 6例、PD 7例,DCR为46.2％;单药组：卡培他滨获SD 2例,吉西他滨获SD 1例、PD 2例,DCR为60.0％。31例化疗患者的中位生存期（OS）为15.7个月,9例未化疗患者的中位OS为4.4个月,差异有统计学意义（P＜0.001）。GEMOX方案组的中位OS为279个月,FOLFOX方案组为152个月,单药组为152个月,差异无统计学意义（P=0.656）。GEMOX方案组的中位无进展生存期（PFS）为7.8个月,FOLFOX方案组为4.0个月,单药组为5.1个月,差异无统计学意义（P=0.053）。常见不良反应多为1～2级,主要为白细胞减少、中性粒细胞减少、贫血、乏力及恶心等。单因素分析显示,浸润深度、分化程度、是否肝转移及是否化疗与晚期十二指肠癌的预后有关（P＜0.05）。Cox多因素分析显示,分化程度、是否肝转移及是否化疗是影响晚期十二指肠癌患者预后的独立因素。结论 GEMOX方案、FOLFOX方案、卡培他滨单药及吉西他滨单药一线化疗均对晚期十二指肠癌有效,且耐受性良好;其中GEMOX方案可能有更好的生存获益。分化程度、是否肝转移及是否化疗可能是影响晚期十二指肠癌患者的预后因素,临床上可作参考。