食管癌患者围放疗期营养不良风险列线图预测模型构建评估  

Construction and evaluation of a nomogram prediction model for periradiotherapy malnutrition risk in patients with esophageal cancer

作　　者：席从林 王利青 戴玲玲 徐芳 严素华 丁颖 杨飞 孙彩凤 董鲜桃 张永杰 Xi Conglin;Wang Liqing;Dai Lingling;Xu Fang;Yan Suhua;Ding Ying;Yang Fei;Sun Caifeng;Dong Xiantao;Zhang Yongjie(Department of Medical Oncology Huai'an Hospital Affiliated to Xuzhou Medical University Huai'an Second People's Hospital,Huai'an 223001 Jiangsu China;Department of Nursing Huai'an Hospital Affiliated to Xuzhou Medical University Huai'an Second People's Hospital,Huai'an 223001 Jiangsu China;Thoracic Surgery Huai'an Hospital Affiliated to Xuzhou Medical University Huai'an Second People's Hospital,Huai'an 223001 Jiangsu China)

机构地区：[1]徐州医科大学附属淮安医院(淮安市第二人民医院)肿瘤内科,江苏淮安223001 [2]徐州医科大学附属淮安医院(淮安市第二人民医院)护理部,江苏淮安223001 [3]徐州医科大学附属淮安医院(淮安市第二人民医院)胸外科,江苏淮安223001

出　　处：《肿瘤代谢与营养电子杂志》2022年第6期765-771,共7页Electronic Journal of Metabolism and Nutrition of Cancer

摘　　要：目的构建食管癌(EC)患者围放疗期营养不良风险的列线图预测模型,并评估模型的预测效能。方法选择2019年3月至2022年3月在徐州医科大学附属淮安医院行放疗的194例EC患者,于放疗结束后1 d以主观整体营养状况评估表(PG-SGA)并结合血清白蛋白水平进行营养不良筛查,根据是否存在营养不良分成营养不良组(PG-SGA评分≥4分且血清白蛋白<35 g/L)和营养良好组(PG-SGA评分<4分或血清白蛋白≥35 g/L)。利用多因素Logistic回归分析确定EC患者围放疗期营养不良风险的影响因素,并基于预测因素构建列线图预测模型,随后用ROC曲线下面积(AUC)和H-L拟合优度对模型的区分度和精准度进行验证。结果83例EC患者出现营养不良,营养不良发生率为42.78%;单因素分析显示,营养不良组与营养良好组年龄、消瘦、家庭人均月收入、是否接受手术、肿瘤分期、伴随消化道症状数量、同步化疗、吞咽障碍、抑郁等9项因素比较有显著差异(P<0.05);Logistic回归分析结果显示,EC患者围放疗期营养不良发生的危险因素有年龄≥60岁、消瘦、肿瘤分期>Ⅱ期、伴随消化道症状数量≥2个、同步化疗、吞咽障碍等6项(P<0.05),EC患者围放疗期营养不良评估回归公式Logit(P)=-11.563+0.958×年龄+1.167×消瘦+0.915×肿瘤分期+0.903×伴随消化道症状数量+1.306×同步化疗+0.839×吞咽障碍;将上述6项危险因素引入R软件建立列线图模型,AUC为0.786>0.75(95%CI=0.722~0.850),校准曲线和理想曲线拟合较好,且拟合优度H-L检验χ^(2)=7.114,P=0.524,表明列线图模型预测EC患者围放疗期发生营养不良的区分度及精准度均较好。结论基于年龄≥60岁、消瘦、肿瘤分期>Ⅱ期、伴随消化道症状数量≥2个、同步化疗、吞咽障碍等6项因素构建的列线图预测模型对EC患者围放疗期营养不良风险具有良好的预测作用,可为肿瘤科医护人员早期对食管癌患者围放疗期�Objective To construct a nomogram prediction model for the risk of malnutrition in patients with esophageal cancer EC during periradiotherapy and to evaluate the predictive performance of the model.Method From March 2019 to March 2022194 EC patients who underwent radiotherapy in our hospital were taken One day after radiotherapy scored Patient-generated Subjective Global Assessment PG-SGA and serum albumin level were used for malnutrition screening.According to the presence or absence of malnutrition they were grouped into a malnutrition group PG-SGA score≥4 and serum albumin<35 g/L and a good nutrition group PG-SGA score<4 or serum albumin≥35 g/L.Multivariate Logistic regression analysis was applied to determine the influencing factors of malnutrition risk in EC patients during periradiotherapy and a nomogram prediction model was constructed based on the predictive factors and then the discriminativeness and precision of the model were verified by the area under the ROC curve AUC and H-L goodness of fit.Result Malnutrition occurred in 83 EC patients and the incidence of malnutrition was 42.78%univariate analysis showed that there were significant differences between the malnutrition group and the good nutrition groupin 9 factors including age thin monthly household income per capita whether to undergo surgery tumor stage the number of accompanying gastrointestinal symptoms concurrent chemotherapy dysphagia and depression P<0.05 Logistic regression analysis showed that the risk factors of malnutrition in EC patients during periradiotherapy were age≥60 years old weight loss tumor stage>stageⅡnumber of accompanying gastrointestinal symptoms≥2 concurrent chemotherapy and dysphagia P<0.05 regression formula of malnutrition assessment in EC patients during periradiotherapy Logit P=-11.563+0.958×age+1.167×weight loss+0.915×tumor stage+0.903×number of accompanying gastrointestinal symptoms+1.306×concurrent chemotherapy+0.839×dysphagia the above 6 risk factors were introduced into R software to establish

关 键 词：食管癌 围放疗期 营养不良 列线图预测模型 

分 类 号：R735.1[医药卫生—肿瘤] R459.3[医药卫生—临床医学]