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研究生:范毓佩
研究生(外文):Yu-Pei Fan
論文名稱:評估與建立女性乳癌患者存活之Nomogram預測模式
論文名稱(外文):Evaluation and Development of a Nomogram Model for Predicting Survival in Female Patients with Breast Cancer
指導教授:蔣以仁蔣以仁引用關係
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫學資訊研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
論文出版年:2010
畢業學年度:98
語文別:中文
論文頁數:45
中文關鍵詞:乳癌Nomogram整體存活率無疾病存活率
外文關鍵詞:Breast CancerNomogramOverall SurvivalDisease-Free Survival
相關次數:
  • 被引用被引用:1
  • 點閱點閱:791
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  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
目的:試圖由癌症資料庫的病患特性、臨床及病理資料找出其規則,辨識出影響女性乳癌病患五年存活的預測因子,並建立癌症病患存活率預測模式。
病患及研究方法:此為回溯性的病例回顧研究,以某家醫院2004-2007年期間癌症登記資料庫登錄的乳癌女性新個案且有接受手術治療及型態學(Behavior)為侵襲性癌為研究對象,個案數共有1016位,追蹤月數的中位數為39個月。運用Cox比例危險模型進行17項變數的分析,找出對整體存活率及無疾病存活率具預測力的因子納入nomogram預測模式。預測模式需經過區別分析與校正檢定。
結果:病患的五年整體存活率達85%,影響整體存活的預測因子包括:年齡、腫瘤大小、淋巴結有癌細胞轉移個數、是否有轉移及動情激素受體等。其Nomogram預測模式的準確性高於NPI,C-index分別為0.80及0.70。影響無疾病存活的預測因子有年齡、腫瘤大小、淋巴結有癌細胞轉移個數及動情激素受體等,Nomogram預測模式的C-index為0.75。
結論:相較於Nottingham Prognostic Index (NPI)預測模式,Nomogram預測模式,加上癌症資料庫的適當欄位作為變數,有較佳的預測結果並能提供病患個別性的存活預測模式,也可進一步整合治療以建立醫療決策之預測模式。

Purpose:The aim of study is to establish a prediction nomogram model to the overall survival(OS) and disease-free survival (DFS) of an individual with breast cancer based on a cancer registry database.
Patients and Methods:In a retrospective cohort study, we use cancer registry database in a hospital. The study included 1016 female patients who had undergone surgery for breast cancer from 2004 to 2007. Primary outcomes were overall and disease free survival rates at a median follow-up time of 39 months. These nomograms to predict OS and DMFS were developed using Cox proportional hazards regression model. The model performance was quantified with respect to discrimination and calibration.
Results:The overall survival in this study was 85%. The overall survival nomogram based on age, tumor size, positive lymph nodes, metastasis and estrogen receptor status had good discrimination and calibration (concordance indices, 0.80). The disease-free survival nomogram based on age, tumor size, positive lymph nodes and estrogen receptor status. The bootstrap-corrected concordance index for disease-free survival nomogram was 0.75).
Conclusion:Our nomograms predict survival accurately and can serve as a basis to integrate future treatment into a clinical prediction model for decision making.

標題 i
審定書 ii
誌謝 iii
目錄 iv
表目錄 vi
圖目錄 vii
中文摘要 viii
英文摘要 ix
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機與目的 1
第二章 文獻回顧 3
2.1 乳癌的診斷與治療 3
2.2 乳癌存活預後因子 5
2.3 預測模式 6
2.3.1 Nottingham Prognostic Index (NPI) 6
2.3.2 Nomogram 7
2.4 Nomogram建置原理 8
2.5 Nomogram於癌症預測的應用 10
2.6 乳癌Nomogram預測模式 11
2.7 Nomogram的判讀 14
2.8 R Project統計軟體 14
第三章 研究材料與方法 16
3.1 資料來源:癌症登記資料庫 16
3.2 研究流程 16
3.3 設定資料選擇條件 18
3.3.1 收案原則 18
3.3.2 癌症資料庫欄位 19
3.4 預測模式 20
3.4.1 存活分析(Survival analysis) 20
3.4.2 設限(Censoring) 20
3.4.3 存活函數(Survival Function) 21
3.4.4 危險函數(Hazard Function) 21
3.4.5 Cox比例危險模型(Cox Proportional hazard Model, Cox PH模型) 21
3.4.6 變數選取 22
3.4.7 預測模式檢定 23
第四章 研究結果 26
4.1 病患特性 26
4.2 存活分析 28
4.3 Nomogram 模式 31
4.4 年齡、ER與存活的相關性 34
第五章 討論 35
5.1 與其他研究的同異性 35
5.2 預測模式的比較 36
5.3 資料品質 37
5.4 研究限制 37
第六章 結論 38
參考文獻 39
附錄一:乳癌存活預測模式相關文獻 42
附錄二:癌症資料庫欄位 43



1.Lin, T.M., K.P. Chen, and B. MacMahon, Epidemiologic characteristics of cancer of the breast in Taiwan. Cancer, 1971. 27: p. 1497-1504.
2.Chie, W.C., et al., Socioeconomic status, lactation and breast cancer risk of parous women in Taiwan. Oncology Reports, 1996. 3: p. 497-501.
3.行政院衛生署國民健康局台灣癌症登記小組. 長期趨勢:年齡標準化發生率長期趨勢(資料僅含侵襲癌). 行政院衛生署國民健康局台灣癌症登記小組:統計分析 [cited 2010年 5月19日]; Available from: http://tcr.cph.ntu.edu.tw/uploadimages/Year_Breast.xls.
4.Coleman, M.P., et al., Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol, 2008. 9(8): p. 730-56.
5.Jasienska, G. and I. Thune, Lifestyle, hormones, and risk of breast cancer. BMJ, 2001. 322(7286): p. 586-7.
6.Boyle, P. and J. Ferlay, Cancer incidence and mortality in Europe, 2004. Ann Oncol, 2005. 16(3): p. 481-8.
7.Mettlin, C., Global breast cancer mortality statistics. CA: A Cancer Journal for Clinicians, 1999. 49(3): p. 138-44.
8.Kamangar, F., G.M. Dores, and W.F. Anderson, Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol, 2006. 24(14): p. 2137-50.
9.行政院衛生署國民健康局台灣癌症登記小組. 國民健康局網站:健康統計資訊 --癌症登記資料. 行政院衛生署國民健康局 2009 [cited 2010年 4月5日]; Available from: http://www.bhp.doh.gov.tw/DOWNLOAD/Statistics/1.癌症登記年度報告(全)(92年以後資料僅含侵襲癌)/Y96-癌症登記年度報告(全).pdf.
10.Veronesi, U., et al., Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New England Journal of Medicine, 2002. 347(16): p. 1227-32.
11.Arriagada, R., et al., Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients. Ann Oncol, 2003. 14(11): p. 1617-22.
12.Society, A.C., How Is Breast Cancer Staged? 2008.
13.Fitzgibbons, P.L., et al., Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med, 2000. 124(7): p. 966-78.
14.Rosen, P.P., et al., Factors influencing prognosis in node-negative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up. J Clin Oncol, 1993. 11(11): p. 2090-100.
15.Chie, W.C., et al., Prognostic factors for the survival of Taiwanese breast cancer patients. J Formos Med Assoc, 2002. 101(2): p. 98-103.
16.Todd, J.H., et al., Confirmation of a prognostic index in primary breast cancer. Br J Cancer, 1987. 56(4): p. 489-92.
17.Galea, M.H., et al., The Nottingham Prognostic Index in primary breast cancer. Breast Cancer Res Treat, 1992. 22(3): p. 207-19.
18.D''Eredita, G., et al., Prognostic factors in breast cancer: the predictive value of the Nottingham Prognostic Index in patients with a long-term follow-up that were treated in a single institution. Eur J Cancer, 2001. 37(5): p. 591-6.
19.Okugawa, H., et al., Prognostic factors in breast cancer: the value of the Nottingham Prognostic Index for patients treated in a single institution. Surg Today, 2005. 35(11): p. 907-11.
20.Rakha, E.A., et al., Prognostic significance of Nottingham histologic grade in invasive breast carcinoma. J Clin Oncol, 2008. 26(19): p. 3153-8.
21.Dreiseitl, S., et al., Nomographic representation of logistic regression models: a case study using patient self-assessment data. J Biomed Inform, 2005. 38(5): p. 389-94.
22.Eastham, J.A., M.W. Kattan, and P.T. Scardino, Nomograms as predictive models. Semin Urol Oncol, 2002. 20(2): p. 108-15.
23.Kattan, M.W., et al., A tool for predicting breast carcinoma mortality in women who do not receive adjuvant therapy. Cancer, 2004. 101(11): p. 2509-15.
24.Partin, A.W., et al., The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol, 1993. 150(1): p. 110-4.
25.Kattan, M.W., T.M. Wheeler, and P.T. Scardino, Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer. J Clin Oncol, 1999. 17(5): p. 1499-507.
26.Hanrahan, E.O., et al., Overall survival and cause-specific mortality of patients with stage T1a,bN0M0 breast carcinoma. J Clin Oncol, 2007. 25(31): p. 4952-60.
27.Rouzier, R., et al., Nomograms to predict pathologic complete response and metastasis-free survival after preoperative chemotherapy for breast cancer. J Clin Oncol, 2005. 23(33): p. 8331-9.
28.Colleoni, M., et al., A risk score to predict disease-free survival in patients not achieving a pathological complete remission after preoperative chemotherapy for breast cancer. Ann Oncol, 2009. 20(7): p. 1178-84.
29.Gilligan, M.A., et al., Relationship between number of breast cancer operations performed and 5-year survival after treatment for early-stage breast cancer. Am J Public Health, 2007. 97(3): p. 539-44.
30.Hennessy, B.T., et al., Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin Oncol, 2005. 23(36): p. 9304-11.
31.Kattan, M.W., et al., A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst, 1998. 90(10): p. 766-71.
32.Ihaka, R. and R. Gentleman, R: a language for data analysis and graphics. Journal of Computational and Graphical Statistics, 1996. 5(3): p. 299-314.
33.Venables, W.N., D.M. Smith, and R.D.C. Team. An Introduction to R. 2010 May 2010 [cited 2010 July 15]; 2.11.1 [Available from: http://www.r-project.org/.
34.林建甫, 存活分析. 初版 ed. 2008, 臺北市:雙葉書廊. 95-230.
35.Iasonos, A., et al., How to build and interpret a nomogram for cancer prognosis. J Clin Oncol, 2008. 26(8): p. 1364-70.
36.Harrell, F.E., Jr., K.L. Lee, and D.B. Mark, Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med, 1996. 15(4): p. 361-87.
37.Yan, L., D. Verbel, and O. Saidi. Predicting prostate cancer recurrence via maximizing the concordance index. 2004; Available from: http://portal.acm.org/citation.cfm?id=1014106.
38.Harrell, F.E., Jr. Design Package. Draw a Nomogram 2008 2009-09-18 [cited 2010 July 15]; 2.3-0:[Available from: http://cran.r-project.org/web/packages/Design/Design.pdf.
39.Chen, K.T., et al., Factors affecting local or regional recurrence in breast cancer. J Formos Med Assoc, 1991. 90(10): p. 986-92.
40.Cheng, S.H., et al., Unique features of breast cancer in Taiwan. Breast Cancer Res Treat, 2000. 63(3): p. 213-23.
41.Krieger, N., Hormone therapy and the rise and perhaps fall of US breast cancer incidence rates: critical reflections. International Journal of Epidemiology, 2008. 37(3): p. 627-37.
42.Pan, H.A., et al., The perception of menopause among women in Taiwan. Maturitas, 2002. 41(4): p. 269-74.
43.Goldhirsch, A., et al., Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol, 2007. 18(7): p. 1133-44.

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