早期胃癌淋巴结转移列线图预测模型的建立及验证  

Establishmen and validation of nomograms predictive model for lymph node metastasis in early gastric cancer

作　　者：石小毛 彭晋[1] 王文博[1] 江换钢[1] 戴静[1] 李炫飞 姜毅楠 周福祥[1] Shi Xiaomao;Peng Jing;Wang Wenbo;Jiang Huangang;Dai Jing;Li Xuanfei;Jiang Yinan;Zhou Fuxiang(Department of Radiation and Medical Oncology,Zhongnan Hospital,Wuhan University/Key Laboratory of Tumor Biology Behavior of Hubei Province/Clinical Cancer Study Center of Hubei Province,Wuhan 430071,China;Department of Gastrointestinal Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院放化疗科,湖北省肿瘤生物学行为重点实验室,湖北省肿瘤医学临床研究中心,430071 [2]武汉大学中南医院胃肠外科,430071

出　　处：《中华实验外科杂志》2021年第7期1340-1344,共5页Chinese Journal of Experimental Surgery

基　　金：肿瘤学领军学科建设支撑项L3临床研究类资助项H;武汉市腹膜癌临床医学研究中心资助项目(201506091102CM62);武汉大学中南医院创新培育基金(znpy2018004)。

摘　　要：目的:构建列线图预测模型以预测早期胃癌患者淋巴结转移,以分选不适宜内镜下切除的早期胃癌患者。方法:收集2004年至2016年SEER数据库中诊断为早期胃癌并接受手术的4035例患者的临床病理资料并进行随机分为主要队列和验证队列。采用单因素和多因素Logistic回归分析确定早期胃癌淋巴结转移的危险因素并构建列线图模型。ROC曲线、C指数及校准曲线评估列线图模型的预测准确性和判别能力,决策曲线分析评估模型的临床应用价值。在内部验证队列中对模型进行内部验证。结果:本研究共纳入早期胃癌4035例,其中774例(19.2%)发生淋巴结转移。多因素Logistic回归分析显示,年龄、分化程度、肿瘤大小和浸润深度是早期胃癌淋巴结转移的独立危险因素。据此构建列线图预测模型,校准曲线显示预测概率与实际概率之间具有良好的一致性,C指数为0.702。列线图在内部验证队列中也有很好的区分度(C指数=0.708)和良好的校准。临床决策曲线分析表明该列线图预测模型的临床应用价值。结论:基于SEER数据库构建预测早期胃癌淋巴结转移风险的列线图模型具有良好预测能力,有助于为早期胃癌患者做出合适的临床决策。Objective To construct nomograms predictive model for predicting lymph node metastasis in patients with early gastric cancer in order to select patients with early gastric cancer who are not suitable for endoscopic resection.Methods The clinicopathological data of 4035 patients diagnosed with early gastric cancer and undergoing surgery in the SEER database from 2004 to 2016 were collected and randomly divided into the main cohort and the verification cohort.Single factor and multivariate logistic regression analyses were used to determine the risk factors of early gastric cancer lymph node metastasis and construct a nomogram model.ROC curve,C index and calibration curve were used to evaluate the predictive accuracy and discriminative ability of the nomogram model,and the decision curve analysis was done to evaluate the clinical application value of the model.The model was internally validated in the internal validation queue.Results A total of 4035 cases of early gastric cancer were included in this study,of which 774 cases(19.2%)had lymph node metastasis.Multivariate logistic regression analysis showed that age,degree of differentiation,tumor size and depth of invasion were independent risk factors for lymph node metastasis in early gastric cancer.Based on this,the nomogram prediction model was constructed.The calibration curve showed a good agreement between the predicted probability and the actual probability,and the C index was 0.702.The nomogram also had good discrimination(C index=0.708)and good calibration in the internal verification cohort.The clinical decision curve analysis showed the clinical application value of the nomogram prediction model.Conclusion The construction of a nomogram model based on the SEER database to predict the risk of early gastric cancer lymph node metastasis has a good predictive ability and is helpful for making appropriate clinical decisions for patients with early gastric cancer.

关 键 词：胃癌 淋巴结转移 

分 类 号：R735.2[医药卫生—肿瘤]