摘要
Abstract
Objective:To develop a predictive model for bone metastasis in patients with prostate cancer based on the SEER database,so as to provide a quantitative assessment tool for early identification of high-risk patients in clinical practice.Methods:A total of 15 055 patients diagnosed with prostate cancer complicated by bone metastasis between January 1,2018 and December 31,2021 were extracted from the SEER database.Stratified random sampling was performed to divide the cohort into a training set(n=10 538)and an internal validation set(n=4 517)at a ratio of 7∶3.Cox proportional hazards regression models were used to screen independent prognostic risk factors associated with overall survival(OS)and cancer-specific survival(CSS)of prostate cancer patients with bone metastasis.Nomogram models for OS and CSS were separately constructed based on the identified independent prognostic factors.The concordance C-index,receiver operating characteristic(ROC)curves,calibration curves and decision curve analysis(DC A)were adopted to comprehensively evaluate the model performance in terms of discrimination,calibration and clinical net benefit.Results:Multivariate Cox regression analysis revealed that age ≥ 80 years,race,marital status,Gleason score of 7-9,T4/TX stage,brain metastasis,liver metastasis,radical resection,radiotherapy and chemotherapy were independent risk factors for OS in patients with prostate cancer(all P＜0.05).Age 50-59 years,age ≥80 years,race,marital status,Gleason score of 7-9,T4/TX stage,brain metastasis,liver metastasis and lung metastasis were independent risk factors for CSS(all P＜0.05).The C-index of the OS nomogram was 0.710(95％CI:0.701-0.718)in the training cohort and 0.710(95％CI:0.697-0.723)in the validation cohort.For the CSS nomogram,the C-index was 0.705(95％CI:0.695-0.715)in the training cohort and 0.697(95％CI:0.682-0.712)in the validation cohort.ROC curves of the OS nomogram yielded AUC values of 0.75,0.72 and 0.72 for survival at 1,2 and 3 years in the training dataset,with corresponding values of 0.74,0.71 and 0.70 in the validation cohort.For the CSS nomogram,the AUC at 1,2 and 3 years were 0.74,0.71 and 0.71 in the training cohort,and 0.72,0.69 and 0.69 in the validation cohort.Calibration curves of the OS nomogram demonstrated favorable consistency between predicted survival probabilities and actual observed survival probabilities.Similarly,calibration curves of the CSS nomogram showed strong agreement between predicted cancer-specific survival probabilities and real-world observations.DCA indicated that both the OS and CSS nomograms achieved higher clinical benefit.Conclusion:The constructed nomogram model was used to predict the 1,2 and 3 year OS and CSS in patients with bone metastatic prostate cancer.The model exhibited favorable discrimination capacity and possessed prominent clinical application value.关键词
前列腺癌/骨转移/SEER数据库/列线图/预后Key words
prostate cancer/bone metastasis/SEER database/nomogram/prognosis分类
医药卫生
