应用竞争风险模型探索宫颈癌患者预后的影响因素
发布时间：2018-11-21 18:50
【摘要】：目的 :探讨竞争风险场合下影响宫颈癌患者预后的因素。方法:选取美国医疗保险监测、流行病学和最终结果(Surveillance,Epidemiology and End Results,SEER)数据库中1988—2008年华人宫颈癌患者的数据。兴趣事件为患者死于宫颈癌,竞争事件为死于其他疾病(如心脏病或其他肿瘤等)。在考虑竞争风险时,运用累积风险模型计算不同诊断年龄、国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期、淋巴结转移程度及放疗情况下兴趣事件的累积发生率,组间比较采用Gray检验;然后,运用Fine-Gray模型进行多因素回归分析。结果 :共有585例宫颈癌患者纳入分析,其中50例患者发生兴趣事件,43例患者发生竞争事件。经Gray检验发现,在不同初诊年龄、FIGO分期、淋巴结转移程度和放疗情况下兴趣事件的累积发生率差异均有统计学意义(P值均0.001);多因素回归分析显示,在Fine-Gray模型中,FIGO分期与淋巴结转移程度是宫颈癌患者预后的独立危险因素(P值均0.05)。在竞争风险存在时,原位癌(0期)、Ⅱ期和Ⅲ期患者死于宫颈癌的相对危险度是Ⅰ期患者的0.022倍、2.34倍和3.57倍,而区域(近端)淋巴结转移和远端淋巴结转移的患者与无淋巴转移的患者相比死于宫颈癌的风险更高(相对危险度分别为2.497和3.518)。结论 :竞争风险模型下,宫颈癌患者的FIGO分期越高,淋巴转移越严重,则预后越差。当存在竞争风险时,应合理运用分析方法和模型来进行数据分析。
[Abstract]:Objective: to investigate the prognostic factors of cervical cancer patients in competitive risk situations. Methods: the data of Chinese patients with cervical cancer from 1988 to 2008 were collected from the American Medical Insurance Surveillance, Epidemiology and final results (Surveillance,Epidemiology and End Results,SEER) database. Events of interest include death from cervical cancer and competition from other diseases (such as heart disease or other tumours). When considering the competitive risk, the cumulative risk model was used to calculate the cumulative incidence of events of interest under different diagnostic ages, (International Federation of Gynecology and Obstetrics,FIGO stages, lymph node metastasis and radiotherapy. Gray test was used to compare the two groups. Then, the Fine-Gray model is used for multivariate regression analysis. Results: a total of 585 patients with cervical cancer were included in the analysis, including 50 patients with interest events and 43 patients with competitive events. Gray test showed that there were significant differences in cumulative incidence of interest events in different age, FIGO stage, lymph node metastasis and radiotherapy (P all 0.001). Multivariate regression analysis showed that FIGO staging and lymph node metastasis were independent prognostic factors of cervical cancer in Fine-Gray model (P < 0. 05). The relative risk of dying from cervical cancer in situ (stage 0), stage 鈪，
本文编号：2347962
[Abstract]:Objective: to investigate the prognostic factors of cervical cancer patients in competitive risk situations. Methods: the data of Chinese patients with cervical cancer from 1988 to 2008 were collected from the American Medical Insurance Surveillance, Epidemiology and final results (Surveillance,Epidemiology and End Results,SEER) database. Events of interest include death from cervical cancer and competition from other diseases (such as heart disease or other tumours). When considering the competitive risk, the cumulative risk model was used to calculate the cumulative incidence of events of interest under different diagnostic ages, (International Federation of Gynecology and Obstetrics,FIGO stages, lymph node metastasis and radiotherapy. Gray test was used to compare the two groups. Then, the Fine-Gray model is used for multivariate regression analysis. Results: a total of 585 patients with cervical cancer were included in the analysis, including 50 patients with interest events and 43 patients with competitive events. Gray test showed that there were significant differences in cumulative incidence of interest events in different age, FIGO stage, lymph node metastasis and radiotherapy (P all 0.001). Multivariate regression analysis showed that FIGO staging and lymph node metastasis were independent prognostic factors of cervical cancer in Fine-Gray model (P < 0. 05). The relative risk of dying from cervical cancer in situ (stage 0), stage 鈪，
本文编号：2347962
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