Individualized Prediction of Overall Survival Time for Patients with Primary Intramedullary Spinal Cord Astrocytoma: A Population-Based Study.

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
World neurosurgery Pub Date : 2025-01-01 Epub Date: 2024-11-21 DOI:10.1016/j.wneu.2024.10.092
Yihao Li, Zezheng Zheng, Qiuju He
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引用次数: 0

Abstract

Background: The incidence rate of primary intramedullary spinal cord astrocytoma (IMSCA) is approximately 0.047 per 100,000 individuals per year, making it the second most common type of intramedullary spinal cord tumor. Due to its rarity, there is a scarcity of related research, and prognostic factors remain unclear. The aim of this study is to identify risk factors affecting the prognosis of patients with primary IMSCA. Based on these factors, we aim to develop and visualize a prognostic model for predicting the overall survival time of patients with this condition, thereby facilitating individualized predictions of overall survival time for patients with primary IMSCA.

Methods: This study selected patients diagnosed with primary IMSCA between 1975 and 2016 from the United States Surveillance, Epidemiology, and End Results database, incorporating a total of 582 eligible patients. We employed the Kaplan-Meier method for survival analysis of various factors to preliminary screen for potential prognostic influences. Univariate and multivariate Cox regression analyses were utilized to identify independent risk factors. A multivariate Cox regression model was constructed, and the model was visualized using a nomogram. Finally, various methods were applied to validate and evaluate the model.

Results: Multivariate Cox analysis revealed that tumor grade, age, and surgical approach are independent prognostic factors for overall survival. A multivariate Cox regression model and a nomogram were developed based on these factors. The overall C-index of the model was 0.764, indicating good discriminative ability. Time-dependent receiver operating characteristic curve analysis showed the model had a good distinction with a 1-year survival rate area under the curve (AUC) of 0.801 (95% confidence interval [CI]: 0.763-0.839), a 3-year survival rate AUC of 0.842 (95% CI: 0.809-0.874), and a 10-year survival rate AUC of 0.855 (95% CI: 0.821-0.888). Calibration plots also demonstrated good model calibration. Decision curve analysis indicated that the nomogram had good clinical utility in predicting 1-year, 3-year, and 10-year overall survival. Internal validation based on enhanced bootstrap resampling showed good consistency between nomogram predictions and actual observations.

Conclusions: Lower World Health Organization's tumor grade, younger age groups, and undergoing gross total resection surgery are significant protective factors affecting the prognosis of patients with primary IMSCA. Among patients with Grade II astrocytoma, being female appears to be a protective factor, whereas being male seems to be a protective factor in Grade III astrocytoma. Radiation therapy and chemotherapy do not appear to improve long-term survival; specifically, radiation therapy may lead to worse outcomes for low-grade spinal cord astrocytomas. The study found no impact of tumor size, year of diagnosis, race, or marital status on prognosis. We have developed the first model and nomogram to predict the prognosis of patients with primary IMSCA, which demonstrates good predictive ability. The nomogram performed well in internal validation, offering a tool to help clinicians predict the overall survival time of patients with primary IMSCA on an individual basis.

原发性髓内脊髓星形细胞瘤患者总生存时间的个体化预测:一项基于人群的研究
背景:原发性脊髓髓内星形细胞瘤的发病率约为每年每十万人中 0.047 例,是第二种最常见的脊髓髓内肿瘤。由于其罕见性,相关研究很少,预后因素仍不明确。本研究旨在确定影响原发性脊髓髓内星形细胞瘤患者预后的风险因素。基于这些因素,我们旨在建立一个预测该病患者总体生存时间的预后模型并将其可视化,从而促进原发性髓内脊髓星形细胞瘤患者总体生存时间的个体化预测:本研究从美国SEER数据库中选取了1975年至2016年间确诊为原发性髓内脊髓星形细胞瘤的患者,共纳入了582名符合条件的患者。我们采用卡普兰-梅耶法对各种因素进行生存分析,初步筛选出潜在的预后影响因素。我们利用单变量和多变量 Cox 回归分析来确定独立的风险因素。建立了多变量 Cox 回归模型,并使用提名图直观显示该模型。最后,采用多种方法对模型进行了验证和评估:多变量 Cox 分析显示,肿瘤分级、年龄和手术方式是总生存率(OS)的独立预后因素。根据这些因素建立了多变量 Cox 回归模型和提名图。该模型的总C指数为0.764,显示出良好的判别能力。时间依赖性 ROC 曲线分析表明,该模型具有良好的区分能力,1 年生存率 AUC 为 0.801 [95% CI:0.763-0.839],3 年生存率 AUC 为 0.842 [95% CI:0.809-0.874],10 年生存率 AUC 为 0.855 [95% CI:0.821-0.888]。校准图也显示了良好的模型校准效果。决策曲线分析(DCA)表明,提名图在预测 1 年、3 年和 10 年 OS 方面具有良好的临床实用性。基于增强引导重采样的内部验证表明,提名图预测结果与实际观察结果之间具有良好的一致性:结论:WHO肿瘤分级较低、年龄较小、接受全切(GTR)手术是影响原发性脊髓髓内星形细胞瘤患者预后的重要保护因素。在 II 级星形细胞瘤患者中,女性似乎是一个保护因素,而在 III 级星形细胞瘤患者中,男性似乎是一个保护因素。放疗和化疗似乎并不能提高长期生存率;特别是放疗可能会导致低级别脊髓星形细胞瘤的预后更差。研究发现,肿瘤大小、诊断年份、种族或婚姻状况对预后没有影响。我们开发了首个预测原发性髓内脊髓星形细胞瘤患者预后的模型和提名图,显示出良好的预测能力。提名图在内部验证中表现良好,为临床医生预测原发性髓内脊髓星形细胞瘤患者的个体总体生存时间提供了一种工具。
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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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