转移性小肠神经内分泌肿瘤预后列线图的建立

目的:分析转移性小肠神经内分泌肿瘤（small intestinal neuroendocrine neoplasms,SI-NENs）的预后相关因素，并建立有效的预测模型。方法:收集美国国家癌症研究所监测、流行病学和最终结果(SEER)数据库中 2010年至2015年491例转移性SI-NENs患者的资料。基于Cox回归模型筛选的独立危险因素建立列线图,并评估该模型的区分度及校准度。结果:患者的中位生存时间为35个月，1年、3年、5年特异生存率分别为96.11%、85.89%、75.87%。Cox回归分析显示年龄、分化程度、组织学类型、手术是患者预后的独立危险因素。列线图一致性指数(C-index) 为0.730（95%CI:0.669～0.791）,且该模型中1年、3年、5年的受试者工作曲线下面积（AUC）分别为0.723、0.699、0.659。1年、3年、5年的校准曲线图亦显示出良好的一致性。结论:年轻、分化程度高、组织学类型为类癌、经历手术的转移性SI-NENs预后较好。列线图的预测效果较好。

Establishment of prognostic nomogram of metastatic small intestinal neuroendocrine neoplasms

Objective:To analyze the prognostic factors of metastatic small intestinal neuroendocrine neoplasms(SI-NENs) and establish an effective prediction model.Methods:Data of 491 patients with metastatic SI-NENs in the national cancer institute surveillance,epidemiology,and end results(SEER) database from 2010 to 2015 were collected.A nomogram was established based on independent risk factors selected by Cox regression model,and the distinction degree and calibration of this model were evaluated.Results:The median survival time was 35 months,and the 1-year,3-year and 5-year survival rates were 96.11%,85.89% and 75.87%,respectively.Age,differentiation grade,histological type,and surgery were independent risk factors for patient prognosis.The Concordance index(C-index) of the nomogram was 0.730（95%CI:0.669～0.791）,and the 1-year,3-year and 5-year AUC of the model were 0.723,0.699 and 0.659,respectively.The calibration curves of 1-year,3-year and 5-year also showed good consistency.Conclusion:Young,well degree of differentiation,histological type of carcinoid,metastatic SI-NENs after surgery have a good prognosis.The predictive effect of nomogram is good.