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投稿时间：2025-02-24 网络发布日期：2025-07-21
投稿时间：2025-02-24 网络发布日期：2025-07-21
中文摘要: 目的 建立基于细胞增殖核抗原Ki67表达的预测晚期胃癌预后的列线图模型并对其进行验证，并探讨不同水平Ki67对同一患者不同治疗线数无进展生存期（PFS）的影响。方法 回顾性收集2020年1月至2023年12月在淮北市人民医院就诊的95名晚期胃癌患者的相关临床资料，采用Cox回归模型进行单因素及多因素生存分析，筛选出影响晚期胃癌总生存期（OS）的独立因素。绘制生存列线图，计算一致性指数（C指数）。通过绘制校准曲线、受试者工作特征曲线（ROC）、临床决策曲线（DCA）验证模型的预测能力。比较Ki67表达高低组(≥50%为高表达，＜50%为低表达）患者在不同治疗线数的PFS。结果 Cox回归风险模型分析显示，年龄、病理类型、东部肿瘤协作组（ECOG）体能状态评分、一线治疗效果是否达到疾病控制率（DCR）及Ki67表达是影响晚期胃癌生存率的独立影响因素（P<0.05）。构建列线图的C指数为0.701（95%CI：0.637~0.765），校准曲线、ROC及DCA曲线均表明构建的模型具有良好的预测能力。Ki67高表达及低表达的晚期胃癌患者在三线阿帕替尼治疗后的PFS分别6.5个月和3.9月，差异有统计学意义（P<0.05），在一、二线以化疗为基础的治疗中PFS差异无统计学意义（P＞0.05）。结论 Ki67为晚期胃癌预后的独立预测因素，结合Ki67建立的列线图能够良好地预测晚期胃癌的生存预后，阿帕替尼可能通过Ki67对晚期胃癌患者的生存产生影响。
Abstract:Objective To establish and validate a nomogram model for predicting the prognosis of advanced gastric cancer based on Ki67 expression，and to explore effect of different levels of Ki67 on progression free survival（PFS）in the same patient with different treatment lines. Methods Clinical data of 95 patients with advanced gastric cancer treated at Huaibei People,s Hospital from January 2020 to December 2023 were retrospectively collected. Univariate and multivariate survival analyses were performed using the Cox regression model to screen independent factors affecting the overall survival（OS）of advanced gastric cancer. A survival nomogram was drawn，and the consistency index（C-index） was calculated. The predictive ability of the model was validated by drawing calibration curves，receiver operating characteristic（ROC）curves，and clinical decision curve analysis（DCA）. The survival periods of patients with high Ki67 expression(≥50%）and low Ki67 expression（<50%）across different treatment lines were compared.Results Cox regression analysis showed that age ，pathological type ，performance status score（ECOG）， whether the first-line treatment achieved disease control rate（DCR），and Ki67 expression were independent prognostic factors affecting the survival rate of advanced gastric cancer（P<0.05）. The C-indexof the constructed nomogram was 0.701（95%CI：0.637-0.765）. Calibration curves，ROC curves，and DCA curves all indicated that the model had good predictive ability. In advanced gastric cancer patients，the PFS after apatinib treatment in the third-line therapy was 6.5 months in the high Ki67 expression group and 3.9 months in the low Ki67 expression group，with a statistically significant difference（P<0.05）. No significant difference in PFS was observed between the two groups in first-and second-line chemotherapy-based treatment（P>0.05）. Conclusion Ki67 is an independent predictive factor for the prognosis of advanced gastric cancer. The nomogram established based on Ki67 can effectively predict the survival prognosis of advanced gastric cancer，and apatinib may have an impact on the survival of patients with advanced gastric cancer through Ki67.
文章编号： 中图分类号：R735.2 文献标志码：A
基金项目:安徽省淮北市科技计划项目（2023HK024）
附件
| Author Name | Affiliation |
| NIU Linjun*，LI Xinzhong，LYU Yongjian | *Department of Oncology,Huaibei People's Hospital,Huaibei,Anhui 235020,China |
引用文本：
牛林军,李心忠,闾永健.基于Ki67构建晚期胃癌预后的预测模型[J].中国临床研究,2025,38(7):1038-1042.
牛林军,李心忠,闾永健.基于Ki67构建晚期胃癌预后的预测模型[J].中国临床研究,2025,38(7):1038-1042.