基于潜在类别分析的喉癌预后分类：超越TNM分期
Latent class analysis-based prognostic classification in laryngeal carcinoma: beyond TNM staging.
文献信息
| PMID | 42914091 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Anna Holgado |
| 作者单位 | Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. |
| 期刊 | Acta otorrinolaringologica espanola |
| SCI 分区 | Q3 |
| IF | 1.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
引言： 本研究旨在利用潜在类别分析（LCA）识别潜在的临床-生物学特征谱，并将其预后能力与TNM系统进行比较。
材料与方法： 对489例喉鳞状细胞癌患者（2000-2020年）进行回顾性研究。LCA使用八个指标变量进行：年龄、性别、毒性物质消耗、亚部位、T分期、N分期、Karnofsky指数和宿主指数。由于I期与II期之间未观察到生存差异（p = 0.056），TNM分期被分为三类（I-II期、III期和IV期）。使用C指数、Royston-Sauerbrei D统计量和积分Brier评分（IBS）比较预后能力。
结果： LCA识别出三个类别：类别1（n = 257，52.6%），早期声门癌，N0；类别2（n = 143，29.2%），功能状态良好的晚期声门上癌；类别3（n = 89，18.2%），以功能受损和不利的炎症-营养特征谱为定义。五年疾病特异性生存率分别为93.9%、74.4%和40.8%（p < 0.001）。与简化TNM相比，LCA获得了更高的Royston-Sauerbrei D统计量（6.73 vs. 5.45；p < 0.001）和更低的预测误差（IBS：0.086 vs. 0.092），而Harrell一致性指数无显著差异（0.758 vs. 0.732；p = 0.39）。在交叉验证分析中，简化TNM在类别3内失去了判别能力（C指数 = 0.560；p = 0.130）。
结论： LCA在喉癌中识别出三种预后特征谱，其风险分层能力高于简化TNM且预测误差更低，突显出一个由宿主状态而非肿瘤范围决定的高风险亚组。
英文摘要
INTRODUCTION: The aim of this study is to identify latent clinical-biological profiles using latent class analysis (LCA) and to compare their prognostic capacity with that of the TNM system.
MATERIALS AND METHODS: A retrospective study of 489 patients with squamous cell carcinoma of the larynx (2000-2020). LCA was performed using eight indicator variables: age, sex, toxic consumption, sub-location, T category, N category, Karnofsky index, and host index. TNM staging was grouped into three categories (stages I-II, III, and IV) as no survival differences were observed between stages I and II (p = 0.056). Prognostic capacity was compared using the C-index, Royston-Sauerbrei D-statistic, and integrated Brier score (IBS).
RESULTS: The LCA identified three classes: Class 1 (n = 257, 52.6%), early glottic carcinoma, N0; Class 2 (n = 143, 29.2%), advanced supraglottic carcinoma with good functional status; and Class 3 (n = 89, 18.2%), defined by functional impairment and an unfavorable inflammatory-nutritional profile. Five-year disease-specific survival was 93.9%, 74.4%, and 40.8%, respectively (p < 0.001). The LCA achieved a higher Royston-Sauerbrei D-statistic (6.73 vs. 5.45; p < 0.001) and a lower prediction error (IBS: 0.086 vs. 0.092) than the simplified TNM, with no significant difference in Harrell's concordance index (0.758 vs. 0.732; p = 0.39). In the cross-validation analysis, the simplified TNM lost its discriminatory power within Class 3 (C-index = 0.560; p = 0.130).
CONCLUSIONS: LCA identifies three prognostic profiles in laryngeal carcinoma with greater risk-stratification capacity and lower prediction error than the simplified TNM, highlighting a high-risk subgroup determined by host status rather than tumor extent.