直径≤5cm的临床早中期非小细胞肺癌纵隔淋巴结转移数学预测模型的建立  

Establishment of a mathematical predictive model of mediastinal lymph node metastasis in early or mid-term non-small cell lung cancer with diameter≤ cm

作　　者：范懿魏 任卫东 史宏灿 束余声 陆世春 孙超 王霄霖 Fan Yiwei;Ren Weidong;Shi Hongcan;Shu Yusheng;Lu Shichun;Sun Chao;Wang Xiaolin(Department of Cardiothoracic Surgery,Clinical Medical College of Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学临床医学院胸外科,225001

出　　处：《国际呼吸杂志》2020年第1期37-43,共7页International Journal of Respiration

基　　金：扬州大学“高端人才支持计划”资助项目(201431)。

摘　　要：目的构建一种判断直径≤5cm的临床早中期非小细胞肺癌(NSCLC)纵隔淋巴结转移的数学预测模型,以期提高肺癌患者术前分期的准确性。方法回顾性分析2012年1月至2017年8月扬州大学临床医学院符合入组标准的NSCLC患者608例,采用SPSS随机数字生成器分组法按3∶1的比例分为建模组和验证组。采用建模组病例资料,通过单因素及多因素分析筛选出纵隔淋巴结转移的独立危险因素,建立数学预测模型。采用验证组病例资料对模型进行外部验证,并与已有的模型进行比较。结果多因素分析结果显示,年龄、肿瘤大小、肿瘤位置(中央型或周围型)、病理类型以及胸膜牵拉征是纵隔淋巴结转移的独立危险因素,建立的数学预测模型为P=ex/(1+ex),其中x=-2831+(0825×肿瘤直径)+(153×中央型)+(0779×胸膜牵拉征)+(1883×病理类型)-(006×年龄)。Hosmer-Lemeshow拟合优度检验显示,预测值和观察值间差异无统计学意义。受试者工作特征曲线的曲线下面积为0763(95%CI:0697~0829)。外部验证结果显示,与VA模型及Fudan模型相比,本模型的适用范围更广,准确率更高。结论本研究所建立的数学模型对直径≤5cm的临床早中期NSCLC纵隔淋巴结转移判断具有较高的敏感度和特异度,其预测能力和准确性均高于其他同类模型,通过该模型可以对是否进行进一步的纵隔淋巴结分期做出更合理的临床决策。Objective To establish a mathematical prediction model of mediastinal lymph node metastasis in early or mid-term non-small cell lung cancer(NSCLC)with diameter 5≤cm and improve the accuracy of preoperative staging of lung cancer.Methods A retrospective analysis of 608 patients with NSCLC meeting the inclusion criteria in the Department of Thoracic Surgery,Clinical Medical College of Yangzhou University from January 2012 to August 2017 was randomly divided into modeling and validation groups according to a 3:1 ratio by SPSS random number generator method.Using the data of the model group,the independent risk factors of mediastinal lymph node metastasis were screened by single factor and multivariate analysis to establish the mathematical prediction model.External validation of the model was performed using validation group case data and compared with previous models.Results Multivariate tumor size,tumor location(central or peripheral),pathological type and pleural traction were independent risk factors for mediastinal lymph node metastasis.The mathematical predictive model established was P=ex/(1+ex),x=-2.831+(0.825 ×tumor diameter)+(1.53×central type)+(0.779 ×pleural traction sign)+(1.883×pathological type)-(0.06×age).The Hosmer-Lemeshow test showed no significant difference between the predicted and observed values.The area under the curve for the receiver operating characteristic curve was 0.763(95%CI:0.697〜0.829).External verification results show that compared with the VA model and the Fudan model,the proposed model is applicable to a wider range and higher accuracy.Conclusions The mathematical model established in this study has high sensitivity and specificity for the diagnosis of mediastinal lymph node metastasis of NSCLC 5≤cm in diameter,and its prediction ability and accuracy are higher than other similar models.This model allows for more rational clinical decisons on whether to perform further mediastinal lymph node.

关 键 词：癌 非小细胞肺 淋巴转移 LOGISTIC模型 临床验证 

分 类 号：R73[医药卫生—肿瘤]