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目的通过分析唾液腺腺样囊性癌(SACC)患者的病历资料,建立生存预测模型,并探讨其临床应用价值。方法分析118例有完整随访资料的SACC患者的病历资料,选择10个可能对患者预后产生影响的临床病理因素,通过Cox模型进行多因素分析,建立预后指数方程。然后根据预后指数(PI)将患者分为高、中、低危险3个组,应用Kaplan Meier法绘制3个组的生存曲线,得到各组总的累积生存率及中位生存时间。结果Cox模型多因素分析显示:SACC确诊时的年龄、临床症状、TNM临床分期、治疗方式、手术切缘与总累积生存率有关(P<0.05)。预后指数方程为PI=0.031X2+0.665X5+0.420X6-0.576X7+0.999X10。根据预后指数分为低危险组(PI<3.57)、中危险组(PI=3.57～4.50)、高危险组(PI>4.50),预后指数越小,患者预后越好。3组的中位生存时间分别为18年、7年和4年,10年总累积生存率分别为83.56%、31.45%和11.20%。结论生存预测模型能够较全面反映SACC患者的预后,可预测不同患者的生存率,为临床治疗提供参考。
Objective To establish a survival prediction model by analyzing the medical records of patients with salivary adenoid cystic carcinoma (SACC), and to explore its clinical value. Methods The clinical data of 118 patients with complete follow-up data were analyzed. Ten clinical and pathological factors that may affect the prognosis were selected and multivariate analysis was used to establish the prognostic index equation. The patients were divided into high, medium and low risk groups according to the prognostic index (PI). Kaplan-Meier method was used to draw the survival curves of the three groups, and the total cumulative survival rate and median survival time were obtained. Results Multivariate analysis of Cox model showed that the age, clinical symptoms, TNM clinical stage, treatment modality, surgical margin and total cumulative survival rate of SACC were correlated (P <0.05). The prognostic index equation was PI = 0.031X2 + 0.665X5 + 0.420X6-0.576X7 + 0.999X10. According to the prognosis index, the patients were divided into low risk group (PI <3.57), medium risk group (PI = 3.57-4.50) and high risk group (PI> 4.50). The smaller the prognostic index, the better prognosis. The median survival time in the three groups was 18 years, 7 years and 4 years, respectively. The 10-year cumulative survival rates were 83.56%, 31.45% and 11.20%, respectively. Conclusion Survival prediction model can reflect the prognosis of patients with SACC more completely, predict the survival rate of different patients and provide reference for clinical treatment.