摘要： 目的 探讨竞争风险时早发性结直肠癌患者的预后影响因素。方法 选取美国SEER数据库中2011年至2015年早发性结直肠癌患者4 226例。在考虑竞争风险的前提下，分别采用Gray检验和Fine-Gray模型进行单因素及多因素分析。结果 Gray检验结果显示，婚姻状况、参保情况、发病位置、肿瘤大小、组织学分级、T分期、N分期和M分期对早发性结直肠癌患者的预后有影响（均P<0.001），种族对早发性结直肠癌患者的预后也有影响（均P=0.001）。多因素竞争风险模型结果显示，组织学分级、婚姻状况、参保情况、T分期、N分期和M分期是影响早发性结直肠癌患者预后的重要因素。结论 竞争风险模型下，未参保，组织学分级越高，T分期、N分期和M分期高的早发性结直肠癌患者的预后更差。

基于竞争风险模型的早发性结直肠癌患者预后影响因素分析

王廉源, 杨毅, 丛慧文, 石福艳, 王素珍

潍坊医学院公共卫生学院卫生统计学教研室, 山东 潍坊 261053

收稿日期:2022-05-07出版日期:2023-03-30发布日期:2023-03-21
通讯作者:石福艳E-mail:shifuyan@126.com
作者简介:王廉源(1997-),男,硕士研究生.
基金资助:国家自然科学基金（81803337，81872719）；国家统计局课题（2018LY79）；山东省自然科学基金（ZR2019MH034）；山东省高等学校青创人才引育计划（2019-6-156，Lu-Jiao）；潍坊医学院博士启动基金（2017BSQD51）


关键词: 竞争风险模型, 早发性, 结直肠癌, 危险因素, 列线图
Abstract: Objective To explore factors influencing survival in patients with early-onset colorectal cancer with competing risk. Methods A total of 4 226 patients with early-onset colorectal cancer from 2011 to 2015 were selected from the US SEER database. The Gray test and Fine-Gray model were used for univariate and multifactorial analyses，respectively，with consideration of competing risks. Results Gray’s test revealed that marital status，insurance status，location，tumor size，histologic grade，T stage，N stage，and M stage had an effect on the prognosis of patients with early-onset colorectal cancer （all P<0.001）. Race also had an effect on the prognosis of patients with early-onset colorectal cancer （P=0.001）. The results of the multifactorial competing risk model showed that histological grade，marital status，insurance status，T stage，N stage，and M stage were important factors affecting the prognosis of patients with early-onset colorectal cancer. Conclusion The prognosis of uninsured，early-onset colorectal cancer patients with higher histologic grade and uninsured，higher T stage，N stage，and M stage patients was worse under the competing risk model.
Key words: competing risk model, early-onset, colorectal cancer, risk factor, nomogram
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