Malignancy Spectrum最新文献

The reliability of multi-source data linkage for population-based cancer survival estimates: A study in a metropolitan cancer registry of China 基于人口的癌症生存率估算中多源数据关联的可靠性：中国大都市癌症登记处的一项研究

Malignancy Spectrum

Pub Date : 2024-09-11 DOI: 10.1002/msp2.43

Yubing Shen, Ruiying Fu, Xiaofeng Wang, Xinyu Zhang, Ying Zhou, Yiheng Zhou, Jue Liu, Dan Mei, Bingfeng Han, Li Li, Shaoming Wang, Ru Chen, Kexin Sun, Hong Lin, Huijuan Mu, Ke Sun, Hongmei Zeng, Wenqiang Wei

Background

Population-based cancer survival is a key metric in evaluating the overall effectiveness of health services and cancer control activities. Advancement in information technology enables accurate vital status tracking through multi-source data linkage. However, its reliability for survival estimates in China is unclear.

Methods

We analyzed data from Dalian Cancer Registry to evaluate the reliability of multi-source data linkage for population-based cancer survival estimates in China. Newly diagnosed cancer patients in 2015 were included and followed until June 2021. We conducted single-source data linkage by linking patients to Dalian Vital Statistics System, and multi-source data linkage by further linking to Dalian Household Registration System and the hospital medical records. Patient vital status was subsequently determined through active follow-up via telephone calls, referred to as comprehensive follow-up, which served as the gold standard. Using the cohort method, we calculated 5-year observed survival and age-standardized relative survival for 20 cancer types and all cancers combined.

Results

Compared to comprehensive follow-up, single-source data linkage overestimated 5-year observed survival by 3.2% for all cancers combined, ranging from 0.1% to 8.6% across 20 cancer types. Multi-source data linkage provided a relatively complete patient vital status, with an observed survival estimate of only 0.3% higher for all cancers, ranging from 0% to 1.5% across 20 cancer types.

Conclusion

Multi-source data linkage contributes to reliable population-based cancer survival estimates in China. Linkage of multiple databases might be of great value in improving the efficiency of follow-up and the quality of survival data for cancer patients in developing countries.

背景基于人口的癌症存活率是评估医疗服务和癌症控制活动整体效果的关键指标。信息技术的进步使我们能够通过多源数据链接准确追踪生命状态。然而，该技术在中国用于生存率评估的可靠性尚不明确。方法我们分析了大连癌症登记中心的数据，以评估多源数据关联在中国基于人群的癌症生存率估算中的可靠性。我们纳入了 2015 年新确诊的癌症患者，并对其进行随访至 2021 年 6 月。我们将患者与大连生命统计系统进行了单源数据关联，并进一步与大连户籍系统和医院病历进行了多源数据关联。随后，通过电话主动随访确定患者的生命状态，这被称为全面随访，也是金标准。我们采用队列方法计算了 20 种癌症和所有癌症的 5 年观察生存率和年龄标准化相对生存率。结果与全面随访相比，单源数据链接将所有癌症的 5 年观察生存率高估了 3.2%，20 种癌症的高估率从 0.1% 到 8.6% 不等。多源数据关联提供了相对完整的患者生命状态，对所有癌症的观察生存率估计仅高出 0.3%，20 种癌症的观察生存率从 0% 到 1.5% 不等。结论多源数据关联有助于可靠地估算中国人群癌症生存率。多个数据库的链接对于提高发展中国家癌症患者的随访效率和生存数据质量具有重要价值。

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引用次数: 0

Neural network models based on clinical characteristics for predicting immunotherapy efficacy in small cell lung cancer 基于临床特征的神经网络模型用于预测小细胞肺癌的免疫疗法疗效

Malignancy Spectrum

Pub Date : 2024-08-04 DOI: 10.1002/msp2.41

Wei Li, Zhaoxin Chen, Mingjun Lu, Zhendong Lu, Siyun Fu, Yuhua Wu, Hong Tao, Liang Shi, Teng Ma, Jinghui Wang

Background

Immunotherapy combined with chemotherapy has been approved as first-line therapy for small cell lung cancer (SCLC) due to the survival benefit in randomized controlled trials. However, predicting its efficacy remains a challenge in the absence of currently available biomarkers.

Methods

A total of 140 individuals with SCLC who received immunotherapy were evaluated retrospectively. These patients were split into two distinct cohorts, the discovery cohort (80% of the total, n = 112) and the validation cohort (20% of the total, n = 28). The objective response rate (ORR), disease control rate (DCR), and responder (progression-free survival [PFS] > 6 months) were all predicted using neural networks.

Results

We developed predictive models for three clinical outcomes. ORR scored 0.8964 area under the receiver operating characteristic curve (AUC) in the discovery cohort and 0.8421 AUC in the validation cohort. DCR model had AUC of 0.8618 in the discovery cohort and AUC of 0.7396 in the validation cohort. The responder model had AUC of 0.8116 in the discovery cohort and AUC of 0.7041 in the validation cohort. The models were then compressed into a doctor-friendly tool.

Conclusion

These neural network-based models, which are based on routine clinical characteristics, accurately predict the efficacy of immunotherapy in patients with SCLC, particularly in terms of ORR.

背景免疫疗法联合化疗在随机对照试验中的生存获益已被批准作为小细胞肺癌（SCLC）的一线疗法。然而，由于目前缺乏可用的生物标志物，预测其疗效仍是一项挑战。方法对接受免疫疗法的 140 名 SCLC 患者进行了回顾性评估。这些患者被分成两个不同的队列，即发现队列（占总数的80%，n = 112）和验证队列（占总数的20%，n = 28）。客观反应率 (ORR)、疾病控制率 (DCR) 和应答者（无进展生存期 [PFS] > 6 个月）均采用神经网络进行预测。结果我们为三种临床结果建立了预测模型。在发现队列中，ORR 的接收者操作特征曲线下面积（AUC）为 0.8964，在验证队列中，接收者操作特征曲线下面积（AUC）为 0.8421。DCR模型在发现队列中的AUC为0.8618，在验证队列中的AUC为0.7396。应答者模型在发现队列中的 AUC 为 0.8116，在验证队列中的 AUC 为 0.7041。随后，这些模型被压缩成一个方便医生使用的工具。结论这些基于神经网络的模型以常规临床特征为基础，能准确预测免疫疗法对SCLC患者的疗效，尤其是在ORR方面。

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引用次数: 0

Estrogen and progesterone receptor expression: Impacts on platinum sensitivity and survival outcomes in high-grade serous ovarian cancer 雌激素和孕激素受体的表达：对高级别浆液性卵巢癌铂敏感性和生存结果的影响

Malignancy Spectrum

Pub Date : 2024-08-04 DOI: 10.1002/msp2.42

Behzat Can, Ezgi Roza Gül, Hüseyin Salih Semiz, Kemal Hansu, Volkan Karataşlı, Sevil Sayhan, Muzaffer Sancı

Background

This study aimed to explore the impact of patient-specific factors on the effectiveness of platinum-based chemotherapy in ovarian cancer patients. Specifically, we investigated the relationship between estrogen receptor (ER) and progesterone receptor (PR) expression levels and platinum sensitivity, and how this influenced treatment outcomes and prognosis. We conducted a survival analysis on patients who underwent surgical treatment for serous ovarian cancer and received platinum-based adjuvant therapies.

Methods

This study was a retrospective observational analysis of 171 patients with high-grade serous ovarian cancer. We extracted and analyzed the patients' clinical data, focusing on platinum sensitivity concerning hormone receptor expression. We also assessed survival outcomes based on receptor expression and platinum resistance.

Results

Our findings revealed that 78.4% (n = 134) of the patients were platinum-sensitive, while 21.6% (n = 37) were platinum-resistant. The expression of hormone receptors showed significant associations with platinum sensitivity, particularly among ER-positive patients (p < 0.05). Age, disease stage, preoperative carbohydrate antigen 125 (CA125) levels, and residual tumor size were identified as notable factors influencing both progression-free survival (PFS) and overall survival (OS). In terms of PFS, 88.5% of patients remained free from disease progression after one year, but this percentage dropped to 21% after five years. The average duration of PFS was 35.3 months. As for OS, 93.5% of patients were still alive after one year, but this percentage decreased to 50.5% after five years. The average survival duration was 64 months. Furthermore, platinum resistance was found to be a significant risk factor for disease progression, with a more than fivefold increase in risk (p < 0.001).

Conclusion

Our study identified disease stage progression, ER negativity, and platinum resistance as the primary factors influencing OS. We also found that ER and PR expression played a crucial role in determining the sensitivity to platinum-based chemotherapy in patients with serous ovarian cancer.

背景本研究旨在探讨患者特异性因素对卵巢癌患者铂类化疗效果的影响。具体而言，我们研究了雌激素受体（ER）和孕激素受体（PR）表达水平与铂类药物敏感性之间的关系，以及这种关系如何影响治疗效果和预后。我们对接受手术治疗的浆液性卵巢癌患者和接受铂类辅助治疗的患者进行了生存分析。方法本研究对 171 例高级别浆液性卵巢癌患者进行了回顾性观察分析。我们提取并分析了患者的临床数据，重点关注与激素受体表达有关的铂敏感性。我们还根据受体表达和铂类耐药性评估了生存结果。结果我们的研究结果显示，78.4%（134 人）的患者对铂类药物敏感，21.6%（37 人）的患者对铂类药物耐药。激素受体的表达与铂敏感性有显著相关性，尤其是ER阳性患者（p < 0.05）。年龄、疾病分期、术前碳水化合物抗原125（CA125）水平和残留肿瘤大小被认为是影响无进展生存期（PFS）和总生存期（OS）的重要因素。在无进展生存期方面，88.5%的患者在一年后仍未出现疾病进展，但五年后这一比例降至21%。PFS的平均持续时间为35.3个月。至于OS，93.5%的患者在一年后仍然存活，但五年后这一比例降至50.5%。平均生存期为 64 个月。此外，研究还发现铂类耐药是疾病进展的重要风险因素，其风险增加了五倍多（p < 0.001）。结论我们的研究发现，疾病分期进展、ER 阴性和铂类耐药是影响 OS 的主要因素。我们还发现，ER 和 PR 的表达在决定浆液性卵巢癌患者对铂类化疗的敏感性方面起着至关重要的作用。

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引用次数: 0

Effect of PD-1/PD-L1 immune checkpoint inhibitor in squamous and nonsquamous non-small cell lung cancer: A systematic review and meta-analysis PD-1/PD-L1免疫检查点抑制剂对鳞状和非鳞状非小细胞肺癌的影响：系统综述与荟萃分析

Malignancy Spectrum

Pub Date : 2024-07-28 DOI: 10.1002/msp2.40

Zhenjie Dai, Jing Chen, Yong Wang

Background

The effects of programmed cell death protein 1/programmed cell death ligand 1 (PD-1/PD-L1) immune checkpoint inhibitors (ICIs) in patients with squamous and nonsquamous non-small cell lung cancer (NSCLC) remain controversial. We conducted a meta-analysis to summarize the existing evidence on this topic.

Methods

We searched PubMed, Medline, and Embase for studies published before December 1, 2022, comparing PD-1/PD-L1 ICIs with docetaxel in squamous and nonsquamous NSCLC patients in any language. The different hazard ratio (HR) values for overall survival (OS) and progression-free survival (PFS) were calculated in this study.

Results

A total of seven studies were identified. In a summary analysis of all studies, the HR values of OS in patients with nonsquamous and squamous NSCLC were 0.73, 95% confidence interval (CI): 0.67–0.79 and 0.70, 95% CI: 0.62–0.79, respectively. In patients with PD-L1 expression levels of 1% or higher, the HR values of OS in nonsquamous and squamous NSCLC patients were 0.60, 95% CI: 0.49–0.74 and 0.72, 95% CI: 0.54–0.96, respectively. The HR values of OS in nonsquamous and squamous NSCLC patients with PD-L1 expression levels of 5% or higher were 0.46, 95% CI: 0.35–0.59 and 0.55, 95% CI: 0.39–0.79, respectively. In nonsquamous and squamous NSCLC patients with PD-L1 expression levels of 10% or higher, the HR values of OS were 0.42, 95% CI: 0.32–0.54, and 0.53, 95% CI: 0.36–0.78, respectively.

Conclusion

The meta-analysis demonstrated possible evidence that there was different efficacy of PD-1/PD-L1 ICIs on OS in squamous and nonsquamous NSCLC patients with different PD-L1 expression levels. Subgroup analysis showed that there was a greater OS benefit in patients with nonsquamous NSCLC.

背景程序性细胞死亡蛋白1/程序性细胞死亡配体1（PD-1/PD-L1）免疫检查点抑制剂（ICIs）对鳞状和非鳞状非小细胞肺癌（NSCLC）患者的作用仍存在争议。我们进行了一项荟萃分析，总结了有关这一主题的现有证据。方法我们在PubMed、Medline和Embase中检索了2022年12月1日前发表的、在鳞状和非鳞状NSCLC患者中比较PD-1/PD-L1 ICIs与多西他赛的研究，研究语言不限。本研究计算了总生存期（OS）和无进展生存期（PFS）的不同危险比（HR）值。结果共发现七项研究。在对所有研究的汇总分析中，非鳞状和鳞状 NSCLC 患者 OS 的 HR 值分别为 0.73（95% 置信区间 (CI)：0.67-0.79）和 0.70（95% 置信区间 (CI)：0.62-0.79）。在PD-L1表达水平达到或超过1%的患者中，非鳞状和鳞状NSCLC患者的OS HR值分别为0.60（95% CI：0.49-0.74）和0.72（95% CI：0.54-0.96）。在PD-L1表达水平达到或超过5%的非鳞癌和鳞癌NSCLC患者中，OS的HR值分别为0.46（95% CI：0.35-0.59）和0.55（95% CI：0.39-0.79）。在PD-L1表达水平达到或超过10%的非鳞癌和鳞癌NSCLC患者中，OS的HR值分别为0.42（95% CI：0.32-0.54）和0.53（95% CI：0.36-0.78）。结论该荟萃分析表明，可能有证据表明，PD-1/PD-L1 ICIs对PD-L1表达水平不同的鳞状和非鳞状NSCLC患者的OS疗效不同。亚组分析显示，非鳞状NSCLC患者的OS获益更大。

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引用次数: 0

Persistent response to combination treatment of pemigatinib and chemotherapy in a patient with advanced gastric cancer: A case report 一名晚期胃癌患者对培美加替尼和化疗联合治疗的持续反应：病例报告

Malignancy Spectrum

Pub Date : 2024-07-25 DOI: 10.1002/msp2.39

Jing Wu, Yuehong Cui, Shan Yu

Objective

This study aimed to report the treatment and outcomes of a patient with advanced gastric cancer (GC) using a combination of a targeted molecular therapy and chemotherapy.

Patients and methods

A 40-year-old woman presented with abdominal metastatic nodules and peritoneal effusion. Biopsy and cytology identified signet ring cell carcinoma. Ten months after the onset of initial symptoms, gastroscopy confirmed signet ring cell carcinoma of the gastric body. Genetic testing revealed amplification of the fibroblast growth factor receptor (FGFR) gene. Consequently, the patient received FGFR inhibitor pemigatinib in addition to a chemotherapy regimen of albumin paclitaxel plus 5-fluorouracil.

Results

During the treatment, the patient experienced recurrent liver function abnormalities and intestinal obstruction, which were managed with symptom-specific medications and supportive therapies. The combined treatment regimen resulted in a progression-free survival (PFS) period of ten months.

Conclusion

The integration of FGFR inhibitor pemigatinib with standard chemotherapy showed promising results in prolonging PFS in a patient with advanced GC characterized by FGFR gene amplification, despite the occurrence of manageable side effects.

本研究旨在报告一名晚期胃癌（GC）患者采用靶向分子疗法和化疗相结合的治疗方法和结果。一名40岁的女性患者出现腹部转移性结节和腹腔积液。活检和细胞学检查发现是标志环细胞癌。最初症状出现 10 个月后，胃镜检查证实她患了胃体标志环细胞癌。基因检测发现成纤维细胞生长因子受体（FGFR）基因扩增。因此，患者在接受白蛋白紫杉醇加5-氟尿嘧啶的化疗方案的同时，还接受了FGFR抑制剂培美加替尼的治疗。治疗期间，患者出现了复发性肝功能异常和肠梗阻，通过对症药物和支持疗法进行了处理。FGFR抑制剂培米加替尼与标准化疗的结合在延长以FGFR基因扩增为特征的晚期GC患者的无进展生存期（PFS）方面显示出良好的效果，尽管出现的副作用尚可控制。

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引用次数: 0

Hotspots and frontiers in cervical cancer research: A bibliometric and visualization analysis from 2013 to 2022 宫颈癌研究的热点和前沿：2013 至 2022 年文献计量和可视化分析

Malignancy Spectrum

Pub Date : 2024-07-16 DOI: 10.1002/msp2.28

Haomeng Zhang, Yunkai Xie, Shuning Chen, Chunjie Piao, Chu Zhang, Weimin Kong

Background

Cervical cancer is a highly aggressive cancer that seriously affects the physical and mental health and quality of life of women, especially for women in developing countries. Therefore, cervical cancer has always been the focus of research, and in recent years, various studies on cervical cancer have emerged one after another.

Methods

Our study aimed to illustrate the development trends in cervical cancer research in China from 2013 to 2022 and compare the findings with studies in other parts of the world during the same period by using bibliometric analysis and the Science Citation Index Expanded. Literature data were analyzed and visualized by using CiteSpace and VOSviewer.

Results

The results show that the number of articles on cervical cancer has increased in recent years, among which articles on the pathogenesis and epidemiological characteristics of cervical cancer account for the majority. The research in China has developed rapidly in recent years, but there is still a certain gap compared with other developed countries.

Conclusion

Bibliometric and visualization analyses offer a unique and objective perspective in the field of cervical cancer and may assist scholars in identifying new research directions.

宫颈癌是一种侵袭性很强的癌症，严重影响妇女的身心健康和生活质量，尤其是发展中国家的妇女。我们的研究旨在通过文献计量学分析和科学引文索引扩展版，说明 2013 年至 2022 年中国宫颈癌研究的发展趋势，并将研究结果与同期世界其他地区的研究进行比较。结果表明，近年来有关宫颈癌的文章数量有所增加，其中关于宫颈癌发病机制和流行病学特征的文章占大多数。文献计量学和可视化分析为宫颈癌领域的研究提供了独特而客观的视角，有助于学者确定新的研究方向。

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引用次数: 0

Forty years of practice against gastric cancer in Linqu County, a high-risk area of gastric cancer in China 中国胃癌高发区临朐县四十年的胃癌防治实践

Malignancy Spectrum

Pub Date : 2024-07-09 DOI: 10.1002/msp2.38

Kai-Feng Pan, Wen-Qing Li, Wei-Cheng You

Gastric cancer (GC) is a global public health burden, with nearly one million new cases diagnosed each year worldwide. To investigate the risk factors and the prevention strategies for GC, in the past 40 years, a series of epidemiological studies have been carried out in Linqu County, Shandong Province, a high-risk area of GC in China. Here, we briefly review the major efforts of 40-year practices against GC in Linqu County, particularly highlighting a case-control study to identify GC risk factors, a cohort study to determine the associations between the risk factors and the progression of gastric lesions, and an intervention trial to prevent GC development.

胃癌（GC）是一种全球性的公共卫生负担，全球每年有近 100 万新确诊病例。为了探究胃癌的危险因素和预防策略，过去 40 年来，中国胃癌高发区山东省临朐县开展了一系列流行病学研究。在此，我们简要回顾了临朐县 40 年来在防治 GC 方面所做的主要工作，特别强调了一项旨在确定 GC 危险因素的病例对照研究、一项旨在确定危险因素与胃病变进展之间关系的队列研究以及一项旨在预防 GC 发生的干预试验。

引用次数: 0

Keep pace with digital innovations 紧跟数字创新步伐

Malignancy Spectrum

Pub Date : 2024-06-02 DOI: 10.1002/msp2.31

Zi Wang, Wenfeng Tu, Yi Yang

引用次数: 0

The necessary role of an efficient tumor immunotherapy by MHC II expression on amateur APCs 业余 APC 上的 MHC II 表达对高效肿瘤免疫疗法的必要作用

Malignancy Spectrum

Pub Date : 2024-05-31 DOI: 10.1002/msp2.29

Jiaxin Zhong, Xiaorong Lin, Hai Hu

Antigen presentation, as the initial step in inducing the activation of T lymphocytes, plays a crucial role in antitumor response. Studies concentrating on major histocompatibility complex class II (MHC II) molecules and the activated CD4⁺ helper T (Th) cells have gained popularity in light of the past limited efficacy of MHC I-activated CD8⁺ T cells alone. In general, MHC II is canonically expressed by professional antigen-presenting cells (pAPCs), yet attempts to increase antigen presentation by dendritic cell (DC) activation have mostly been unsuccessful. In recent years, a number of studies have found that a variety of cells, including cancer cells, fibroblasts, vascular endothelial cells (VECs), and lymphoid stromal cells (LSCs), are considered amateur APCs (aAPCs) and can express MHC II molecules, which have piqued the interest of researchers. These groups vastly outnumber DCs or macrophages, and it has been confirmed that they also qualify as antigen-presenting complexes that are functionally related to conventional pAPCs. Herein, we will review current research regarding the antigen presentation process of MHC II, its advances in APC surfaces, especially for aAPCs, the special mechanisms of regulation of MHC II on aAPCs, and combination therapy targeting MHC II as a possible treatment strategy in cancer.

抗原递呈是诱导 T 淋巴细胞活化的第一步，在抗肿瘤反应中起着至关重要的作用。鉴于过去仅靠 MHC I 激活 CD8+ T 细胞的效果有限，对主要组织相容性复合体 II 类（MHC II）分子和激活的 CD4+ 辅助 T（Th）细胞的研究越来越受欢迎。一般来说，MHC II 通常由专业抗原递呈细胞（pAPC）表达，但通过激活树突状细胞（DC）来增加抗原递呈的尝试大多不成功。近年来，一些研究发现，癌细胞、成纤维细胞、血管内皮细胞（VECs）和淋巴基质细胞（LSCs）等多种细胞被认为是业余的抗原递呈细胞（aAPCs），可以表达 MHC II 分子，这引起了研究人员的兴趣。这些细胞群的数量远远超过 DC 或巨噬细胞，而且已证实它们也可作为抗原递呈复合物，在功能上与传统的 pAPCs 相关。在此，我们将回顾目前有关 MHC II 抗原递呈过程、其在 APC 表面（尤其是 aAPCs）的进展、MHC II 在 aAPCs 上的特殊调控机制以及以 MHC II 为靶点的联合疗法作为一种可能的癌症治疗策略等方面的研究。

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引用次数: 0

Competing-risks model for predicting the prognosis of patients with regressive melanoma based on the SEER database 基于 SEER 数据库预测黑色素瘤退变患者预后的竞争风险模型

Malignancy Spectrum

Pub Date : 2024-04-08 DOI: 10.1002/msp2.25

Chaodi Huang, Liying Huang, Jianguo Huang, Xinkai Zheng, Congjun Jiang, Kong Ching Tom, U. Tim Wu, WenHsien Ethan Huang, Yunfei Gao, Fangmin Situ, Hai Yu, Liehua Deng, Jun Lyu

Background

The relationship between the regression and prognosis of melanoma has been debated for years. When competing-risk events are present, using traditional survival analysis methods may induce bias in the identified prognostic factors that affect patients with regressive melanoma.

Methods

Data on patients diagnosed with regressive melanoma were extracted from the Surveillance, Epidemiology, and End Results (SEER) database during 2000–2019. Cumulative incidence function and Gray's test were used for the univariate analysis, and the Cox proportional-hazards model and the Fine–Gray model were used for the multivariate analysis.

Results

A total of 1442 eligible patients were diagnosed with regressive melanoma, including 529 patients who died: 109 from regressive melanoma and 420 from other causes. The multivariate analysis using the Fine–Gray model revealed that SEER stage, surgery status, and marital status were important factors that affected the prognosis of regressive melanoma. Due to the existence of competing-risk events, the Cox model may have induced biases in estimating the effect values, and the competing-risks model was more advantageous in the analysis of multiple-endpoint clinical survival data.

Conclusion

The findings of this study may help clinicians to better understand regressive melanoma and provide reference data for clinical decisions.

黑色素瘤的消退与预后之间的关系已争论多年。当存在竞争风险事件时，使用传统的生存分析方法可能会导致已确定的影响黑色素瘤退行性患者的预后因素出现偏差。累计发病率函数和格雷氏检验用于单变量分析，Cox比例危险模型和Fine-Gray模型用于多变量分析。共有1442名符合条件的患者被确诊为黑色素瘤退变型，其中529名患者死亡：109人死于黑色素瘤退变型，420人死于其他原因。使用Fine-Gray模型进行的多变量分析显示，SEER分期、手术状态和婚姻状况是影响退行性黑色素瘤预后的重要因素。由于存在竞争风险事件，Cox模型在估计效应值时可能会产生偏差，而竞争风险模型在分析多终点临床生存数据时更具优势。

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引用次数: 0