预测放射性下颌骨坏死术后复发的列线图模型建立  

ESTABLISHMENT OF A NOMOGRAM MODEL FOR PREDICTING RECURRENCE AFTER MANDIBULAR OSTEORADIONECROSIS SURGERY

作　　者：韩煜 刘忠龙 祝奉硕 李晓光[1] 何悦[1] HAN Yu;LIU Zhonglong;ZHU Fengshuo;LI Xiaoguang;HE Yue(Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔医学院口腔颌面-头颈肿瘤科,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海200011

出　　处：《精准医学杂志》2020年第5期394-399,共6页Journal of Precision Medicine

基　　金：国家自然科学基金面上项目(NSFC:81570949);上海市卫生计生系统优秀学科带头人培养计划(2017BR019);申康第一轮促进市级医院临床技能与临床创新三年行动计划(16CR2038B)。

摘　　要：目的通过分析影响放射性下颌骨坏死(ORNM)患者根治切除术术后复发的可能因素,构建预测ORNM术后复发的列线图模型。方法对2003—2016年就诊于我院口腔颌面-头颈肿瘤科的ORNM患者进行了回顾性研究,通过Kaplan-Meier分析初步筛选所有患者,利用Cox回归模型确定ORNM术后复发的影响因素,绘制ROC曲线和校准曲线评估该模型的性能。以ORNM的术后复发作为主要的结局变量,进行单变量和多变量分析。结果本研究共纳入213例患者,ORNM术后复发率为24.4%(52/213)。在Cox回归模型中,放射剂量、ORNM发生的部位、S分类、外科手术术式等因素与术后复发密切相关。本研究以此为基础构建了列线图模型来预测ORNM患者的术后复发。构建的列线图模型能够较为准确地评估术后复发的风险与患者无复发生存率,ROC曲线下面积为0.813。校正曲线的结果则显示出了足够的一致性。结论本研究构建的列线图模型能够较为准确地预测ORNM患者的术后复发率。Objective To investigate the possible influencing factors for recurrence after radical resection in patients with osteoradionecrosis of the mandible(ORNM),and to establish a nomogram model for predicting postoperative recurrence of ORNM.MethodsA retrospective analysis was performed for ORNM patients who attended Department of Oral&Maxillofacial-Head&Neck Oncology in our hospital from 2003 to 2016.The Kaplan-Meier analysis was used for preliminary screening of all patients,the Cox regression model was used to identify the influencing factors for postoperative recurrence of ORNM,and the receiver operating characteristic(ROC)curve and the calibration curve were used to evaluate the performance of this model.Univa-riate and multivariate analyses were performed with postoperative recurrence of ORNM as the primary outcome variable.\ResultsA total of 213 patients were analyzed,and the postoperative recurrence rate was 24.4%(52/213).In the Cox regression model,radiation dose,location of ORNM,S classification,and surgical procedure were closely associated with postoperative recurrence,and then a nomogram model was established on this basis to predict postoperative recurrence in the patients with ORNM.The nomogram model established accurately predicted the risk of postoperative recurrence and relapse-free survival rate,with an area under the ROC curve of 0.813.The calibration curve showed sufficient consistency.\Conclusion\The nomogram model established in this study can accurately predict postoperative recurrence rate in ORNM patients.

关 键 词：下颌骨 放射性颌骨坏死 复发 危险因素 回归分析 列线图 回顾性研究 

分 类 号：R818.88[医药卫生—放射医学] R782[医药卫生—临床医学]