老年肾透明细胞癌患者预后风险模型的构建及验证OA

Objective:To explore the risk factors affecting the prognosis of elderly patients with clear cell renal cell carcinoma(ccRCC)and construct a novel prognostic model.Methods:Within Surveillance,Epidemiology,and End Results(SEER)registry database,10 236 elderly ccRCC patients were randomly assigned to the training groups and validation groups at a ratio of 7∶3.Multivariate Cox regression analysis was used to identify independent risk factors for the prognosis of elderly ccRCC patients.A prognostic model was constructed based on the regression coefficients of each factor in the Cox regression analysis,and a nomogram was established to predict the overall survival(OS),and cancer specific survival(CSS)at 1,3,and 5 years in elderly ccRCC patients.The model were evaluated by receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis.The model was validated using data from the validation groups.Results:Multivariate Cox regression analysis showed that age,gender,race,marital status,tumor size,histological grade,T stage,N stage,M stage,surgical method,lymph node dissection,venous infiltration and metastatic site were independent risk factors for OS in elderly ccRCC patients(all P＜0.05).In contrast,the independent risk factors for CSS included age,tumor size,histological grade,pathological stage,N stage,M stage,surgical method,venous infiltration and metastatic site(all P＜0.05).The ROC curve of the OS model showed that the AUC values for 1,3 and 5 year OS were 0.75,0.74 and 0.72 in the training groups,and 0.74,0.74 and 0.72 in the validation groups,respectively.For the CSS nomogram,the AUC values for 1,3 and 5 year OS were 0.84,0.84 and 0.82 in the training groups,and 0.83,0.84 and 0.81 in the validation groups.The calibration curve showed that the nomogram predicted patient survival was highly consistent with actual survival.The clinical decision curve showed a higher net clinical benefit in the prognostic model than the TNM model.Conclusion:The nomogram model for predicting 1,3 and 5 year OS and CSS in elderly ccRCC patients has good discriminative ability,model fit,and clinical net benefit.