食管癌适形调强放疗病人预后多因素回归分析及其预测模型构建

目的探究食管癌适形调强放疗病人预后的影响因素，并根据可能影响因素构建可预测病人预后的Nomogram模型。方法回顾性分析2012年9月至2015年10月接受适形调强放疗的80例食管癌病人。采用Kaplan-Meier法计算食管癌病人1、2、3、5年生存率，以Log Rank法行单因素预后分析，以Cox法多因素分析筛选影响病人生存的独立因素，并利用R软件建立Nomogram预测模型。结果病人随访中位时间是36个月，1、2、3、5年生存率依次为72.50%、61.25%、53.75%和22.50%。单因素分析显示，肿瘤长度、T分期、N分期、TNM分期、化疗应用、大体肿瘤体积(GTV)、单个或多发病灶、放疗剂量与病人适形调强放疗预后有关(P < 0.05~P < 0.01)；Cox多因素分析显示，N分期、化疗应用、放疗剂量、GTV是影响食管癌适形调强放疗预后的独立预测因素(P < 0.01)。获得Nomogram预测模型的一致性指数C-index为0.746(95%CI:0.633~0.895)。结论N分期、化疗应用、放疗剂量、GTV是影响食管癌适形调强放疗病人预后的独立影响因素，基于以上结果构建的Nomogram模型预测食管癌病人预后的效果良好。

Multivariate regression analysis of the prognosis of esophageal cancer patients with intensity modulated radiotherapy and its prediction model construction

ObjectiveTo investigate the prognostic factors of intensity modulated radiotherapy(IMRT) in esophagus cancer, and construct a Nomogram model to predict the prognosis of patients.MethodsThe clinical data of 80 esophageal cancer patients treated with IMRT from September 2012 to October 2015 were retrospectively analyzed.The Kaplan-Meier method was used to calculate the 1-year, 2-year, 3-year and 5-year survival rates of esophageal cancer patients, the Log Rank method was used to perform univariate prognostic analysis, the Cox method was used to screen the independent factors affecting survival, and the R software was used to establish a Nomogram prediction model.ResultsThe median time of follow-up was 36 months.The 1-year, 2-year, 3-year and 5-year survival rates were 72.50%, 61.25%, 53.75% and 22.50%, respectively.The results of univariate analysis showed that the tumor length, T stage, N stage, TNM stage, chemotherapy application, gross tumor volume(GTV), single or multiple lesions, radiotherapy dose were related to the prognosis of patients with IMRT(P < 0.05 to P < 0.01).The results of Cox multivariate analysis showed that the N stage, chemotherapy application, radiotherapy dose and GTV were the independent predictors of the prognosis of esophageal cancer(P < 0.01).The C-index of this Nomogram prediction model was 0.746(95%CI: 0.633-0.895).ConclusionsThe N stage, chemotherapy application, radiotherapy dose and GTV are the independent factors of influencing the prognosis of patients with esophageal cancer, and this Nomogram model based on the above results can well predict the prognosis of patients with esophageal cancer.