颅内单纯生殖细胞瘤患者的生存预测：基于SEER数据库的临床研究

doi:10.3877/cma.j.issn.2095-9141.2023.05.005

目的

基于SEER数据库构建颅内单纯生殖细胞瘤生存预测的风险分层框架和诺模图。

方法

利用监测、流行病学和最终结果（SEER）数据库收集自2000年1月至2019年12月确诊为颅内单纯生殖细胞瘤患者的人口统计学、生存结果和治疗方法等信息。通过Kaplan-Meier曲线和Cox比例风险模型评估生存模式，并设计诺模图来评价颅内单纯生殖细胞瘤患者的预后，通过一致性指数（C指数）评价预测模型的准确性。

结果

将年龄、性别、种族、放射治疗、化学治疗和手术因素构建颅内单纯生殖细胞瘤患者3年及5年生存期（OS）的预测模型，诺模图C指数为0.64。根据诺模图计算的风险得分分为低风险评分（≥140.67分）和高风险评分（<140.67分），Kaplan-Meier生存曲线分析显示，年龄<20岁、接受化学治疗、低风险评分患者表现出较长的OS，差异有统计学意义（P<0.05），而性别、种族、放射治疗、手术治疗对患者OS的影响差异无统计学意义（P>0.05）。

结论

构建原发性颅内生殖细胞瘤患者生存预测的诺模图与风险分层机制，有利于临床医生对颅内单纯生殖细胞瘤患者的OS进行预测。

关键词: 颅内生殖细胞瘤, 生殖细胞瘤, 生存预测, SEER数据库

Objective

To construct a risk stratification framework and nomogram for predicting the survival of intracranial germ cell tumors based on the SEER database.

Methods

The surveillance, epidemiology, and end results (SEER) database was used to collect demographic, survival, and treatment information for patients diagnosed with intracranial germinoma simplex from January 2000 to December 2019. Kaplan-Meier curve and Cox proportional risk model were used to evaluate the survival mode, and a nomogram was designed to evaluate the prognosis of patients with simple intracranial germ-cell tumor. The concordance index (C-index) was used to evaluate the accuracy of the prediction model.

Results

A predictive model for 3-year and 5-year overall survival (OS) of patients with intracranial simple germ cell tumors was constructed based on factors such as age, gender, race, radiation therapy, chemotherapy, and surgery. The nomogram C-index was 0.64. The risk score calculated based on the nomogram were divided into low-risk scores (≥140.67 points) and high-risk scores (<140.67 points). Kaplan Meier survival curve analysis showed that patients younger than 20 years old, receiving chemotherapy and low-risk score showed a longer survival period, and the difference was statistically significant (P<0.05). However, there was no statistically significant difference in the impact of gender, race, radiation therapy, and surgical treatment on the overall survival rate of patients (P>0.05).

Conclusion

The construction of nomogram and risk stratification mechanism for survival prediction of patients with primary intracranial germinoma is helpful for clinicians to predict the OS in patients with simple intracranial germinoma.

Key words: Intracranial germ cell tumor, Germinoma, Survival prediction, SEER database

表1 338例患者的人口学特征和临床病理特征

Tab.1 Demographic and clinicopathological characteristics of 338 patients

项目	例数（%）
年龄（岁）
<20	231（68.3）
≥20	107（31.7）
性别
女性	104（30.8）
男性	234（69.2）
种族
黑人	33（9.8）
白人	224（66.3）
其他	81（24.0）
诊断年份
2000~2009年	172（50.9）
2010~2019年	166（49.1）
放射治疗
否	44（13.0）
是	294（87.0）
化学治疗
否	110（32.5）
是	228（67.5）
手术
否	183（54.1）
是	155（45.9）

表1 338例患者的人口学特征和临床病理特征

Tab.1 Demographic and clinicopathological characteristics of 338 patients

项目	例数（%）
年龄（岁）
<20	231（68.3）
≥20	107（31.7）
性别
女性	104（30.8）
男性	234（69.2）
种族
黑人	33（9.8）
白人	224（66.3）
其他	81（24.0）
诊断年份
2000~2009年	172（50.9）
2010~2019年	166（49.1）
放射治疗
否	44（13.0）
是	294（87.0）
化学治疗
否	110（32.5）
是	228（67.5）
手术
否	183（54.1）
是	155（45.9）

图1 颅内单纯生殖细胞瘤患者的多变量Cox回归分析森林图

Fig.1 Multivariate Cox regression analysis of patients with simple intracranial germinoma forest

图2 颅内单纯生殖细胞瘤患者3年及5年生存率的诺模图模型

Fig.2 Normogram models of 3-year and 5-year overall survival in patients with simple intracranial germinoma

图3 年龄、性别、化射治疗、放射治疗、手术及风险评分的Kaplan-Meier生存曲线A：年龄；B：性别；C：化学治疗；D：放射治疗；E：手术；F：风险评分

Fig.3 Kaplan-Meier survival curves for age, sex, chemotherapy, radiotherapy, surgery, and risk scores

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Survival prediction of patients with intracranial simple germ cell tumors: a clinical study based on SEER database

模态框（Modal）标题

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Survival prediction of patients with intracranial simple germ cell tumors: a clinical study based on SEER database