女性早期胃癌患者淋巴结转移列线图预测模型的构建及验证  

Construction and validation of a nomogram for prediction of lymph node metastasis in female patients with early gastric cancer

作　　者：韦之见[1] 罗盼权 陈章明[1] 韩文秀[1] 李永翔[1] 徐阿曼[1] WEI Zhijian;LUO Panquan;CHEN Zhangming;HAN Wenxiu;LI Yongxiang;XU Aman(Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230022

出　　处：《临床肿瘤学杂志》2022年第11期990-996,共7页Chinese Clinical Oncology

基　　金：安徽省自然科学基金青年项目(2108085QH337);安徽省重点研究与开发计划资助项目(202104j07020029)。

摘　　要：目的探讨女性早期胃癌患者淋巴结转移的危险因素,构建列线图模型并检验预测效能。方法回顾性分析2015年1月至2021年12月女性早期胃癌患者398例,依据院区不同分为训练集(n=328)和验证集(n=70)。分析淋巴结转移与胃癌临床病理特征的关系,采用Logistic回归模型分析胃癌淋巴结转移的独立因素,采用R软件构建列线图预测模型并进行内外部验证。结果训练集328例胃癌患者中,53例(16.2%)发生淋巴结转移;验证集70例患者中,13例(18.6%)发生淋巴结转移。训练集中,淋巴结转移与肿瘤大小、血小板与淋巴细胞比值(PLR)、肿瘤位置、绝经、脉管浸润、神经侵犯、分化程度和浸润深度有关(P<0.05),与年龄、中性粒细胞与淋巴细胞比值(NLR)、白蛋白、CEA、CA125、CA199、大体分型、吸烟史和饮酒史无关(P>0.05)。Logistic回归模型分析显示,肿瘤大小、绝经、脉管浸润、浸润深度和PLR是影响女性早期胃癌淋巴结转移的独立因素(P<0.05)。根据此结果构建列线图模型,训练集和验证集C指数分别为0.869(95%CI:0.816~0.923)和0.858(95%CI:0.736~0.980),表明列线图模型预测效能良好。结论本研究构建的列线图模型具有良好的预测能力,对女性早期胃癌患者治疗方案的选择有一定的指导价值。Objective To investigate the risk factors of lymph node metastasis in female patients with early gastric cancer,and construct a nomogram prediction model,which is evaluated for the predictive accuracy.Methods Retrospective analysis was made on 398 female patients with early gastric cancer from January 2015 to December 2021.The patients were divided into training set(n=328)and validation set(n=70)according to different hospital areas.The relationship between lymph node metastasis and clinicopathological characteristics of gastric cancer was analyzed.Logistic regression model was used to analyze the independent factors of lymph node metastasis of gastric cancer.The nomogram prediction model was constructed with R software and verified internally and externally.Results In the training set of 328 patients with gastric cancer,53(16.2%)had lymph node metastasis;In the validation set of 70 patients,13 patients(18.6%)had lymph node metastasis.Training focused,lymph node metastasis was related to tumor size,platelet to lymphocyte ratio(PLR),tumor location,menopause,vascular invasion,nerve invasion,degree of differentiation and depth of invasion(P<0.05),but not to age,granulocyte/lymphocyte(NLR),albumin,CEA,CA125,CA199,general classification,smoking history and drinking history(P>0.05).Tumor size,menopause,vascular invasion,depth of invasion and PLR were independent factors affecting lymph node metastasis of early gastric cancer in women(P<0.05).According to this result,the nomograph model was constructed.The C-index values of training set and validation set were 0.869(95%CI:0.816-0.923)and 0.858(95%CI:0.736-0.980),respectively,indicating that the prediction efficiency of the nomograph model was good.Conclusion The nomogram based on the risk factors of lymph node metastasis in female early gastric cancer have a good predictive ability,which is beneficial for the selection of treatment options clinically.

关 键 词：胃癌 女性 淋巴结转移 列线图 

分 类 号：R735.2[医药卫生—肿瘤]