基于SEER数据库分析胆囊癌肝转移患者预后因素并构建竞争风险列线图

目的:分析影响胆囊癌肝转移患者的预后因素，建立竞争风险列线图从而量化生存差异，提供临床决策。方法:本研究通过回顾性分析SEER数据库2010年至2015年共318例胆囊癌肝转移患者完整临床信息资料，采用单因素和多因素Cox回归分析得到影响患者总生存期的独立预后因素，采用Kaplan-Meier（Log-rank 检验）进行生存分析，并基于独立预后因素绘制竞争风险列线图。结果:318例胆囊癌肝转移患者，采用总生存期单因素和多因素Cox回归分析，结果显示病理分级(HR:1.397，95%CI:1.157~1.687，P<0.001)、手术方式(HR:0.790，95%CI:0.682~0.913，P=0.002)、化疗情况(HR:0.344，95%CI:0.265~0.446，P<0.001)和淋巴结检出数(HR:0.774，95%CI:0.642~0.933，P=0.007)是胆囊癌肝转移患者总生存期独立预后因素。通过将多因素Cox回归分析得到的显著临床病理参数建立列线图来评估影响总生存期的竞争性风险和量化生存差异。计算列线图C-index为7.46，并且0.5年、1年、3年的校正曲线显示列线图有着较好预测能力。结论:肿瘤病理分级、手术方式、淋巴结检出数和化疗情况是胆囊癌肝转移患者独立预后因素。基于列线图显示，化疗情况影响程度的权重值最大。

Analysis of prognostic factors of patients with hepatic metastases from gallbladder cancer and construction of competitive risk nomogram based on SEER database

Objective:To analyze the prognostic factors affecting patients with hepatic metastases from gallbladder cancer，and establish a competitive risk nomogram to quantify survival differences and provide clinical decisions.Methods:This study retrospectively analyzed 318 patients with hepatic metastases from gallbladder cancer from 2010 to 2015 in the SEER database.The independent prognostic factors affecting the overall survival of patients were obtained using univariate and multivariate Cox regression analysis.Kaplan-Meier(Log-rank test) was performed for survival analysis.Based on independent prognostic factors，a nomogram was drawn.Results:318 patients with hepatic metastases from gallbladder cancer were analyzed by univariate and multivariate Cox regression analysis.The results showed pathological grade(HR:1.397，95%CI:1.157~1.687，P<0.001)，surgical method(HR:0.790，95%CI:0.682~0.913，P=0.002)，chemotherapy(HR:0.344，95%CI:0.265~0.446，P<0.001)，and regional lymph nodes examed(HR:0.774，95%CI:0.642~0.933，P=0.007) were independent prognostic factors for overall survival in patients with hepatic metastases from gallbladder cancer.The significant clinical-pathological parameters obtained by multivariate Cox regression analysis were used to establish a nomogram to evaluate the competitive risk affecting the overall survival and to quantify the difference in survival.The calculated C-index of the nomogram was 7.46，P<0.001，and the 0.5-year，1-year，and 3-year calibration curves showed that the nomogram had a better predictive ability.Conclusion:Tumor pathological grade，surgical method，regional lymph nodes examed，and chemotherapy are independent prognostic factors for patients with hepatic metastases from gallbladder cancer.Based on the nomogram，the weight of the effect of chemotherapy is the largest.