复康宁胶囊对三阴性乳腺癌新辅助化疗后贫血危险因素分析及风险预测模型的构建与验证  

Establishment and validation of a nomogram model for detect the risk of anemia after chemotherapy for the triple-negative breast cancer patients with Fukangning

作　　者：林森[1] 廖美容[2] 唐瑞俊 梁云[4] Lin Sen;Liao Meirong;Tang Ruijun;Liang Yun(Department of Breast Surgery,Guilin Municipal Hospital of Traditional Chinese Medicine,Guilin 541002,China;Department of Neurology,Guilin Municipal Hospital of Traditional Chinese Medicine,Guilin 541002,China;Department of Pathology,Guilin Municipal Hospital of Traditional Chinese Medicine,Guilin 541002,China;Department of Radiology,Guilin Municipal Hospital of Traditional Chinese Medicine,Guilin 541002,China)

机构地区：[1]桂林市中医医院乳腺科,桂林541002 [2]桂林市中医医院神内科,桂林541002 [3]桂林市中医医院病理科,桂林541002 [4]桂林市中医医院放射科,桂林541002

出　　处：《国际中医中药杂志》2023年第5期537-542,共6页International Journal of Traditional Chinese Medicine

基　　金：广西壮族自治区中医药管理局自筹经费科研课题(GXZYZ20210202)。

摘　　要：目的探讨复康宁胶囊对三阴性乳腺癌(TNBC)新辅助化疗(NAC)后发生贫血的危险因素分析及风险预测模型的构建与验证,为降低TNBC-NAC后贫血发生率提供参考。方法回顾性选择2016年1月-2021年7月本院乳腺外科316例服用复康宁胶囊的女性TNBC-NAC患者为研究对象(建模集),以末次化疗后是否发生贫血分为对照组和观察组。另选择2022年2-9月本院98例乳腺癌患者作为验证对象。采用多因素Logistic回归分析复康宁胶囊对TNBC-NAC后贫血的影响;采用R语言建立化疗后贫血风险列线图预测模型及校准曲线,并进行内部验证与外部验证;Hosmer-Lemeshow检验评价列线图模型的风险预测值与实际观测值的预测偏差,ROC曲线评价模型的预测效果。结果316例患者中75例发生贫血,贫血率为23.73%。多因素Logistic回归分析结果显示,绝经[OR(95%CI)为26.739(5.063~141.227)]、RBC[OR(95%CI)为0.168(0.098~0.286)]、Hb水平[OR(95%CI)为0.952(0.929~0.976)]、病理分期Ⅲ期[OR(95%CI)为4.182(1.759~9.946)]是TNBC-NAC后贫血的独立危险因素(P<0.05)。基于上述影响因素建立列线图预测模型,Hosmer-Lemeshow检验结果显示,该列线图模型的风险预测值与实际观测值的预测偏差比较,差异无统计学意义(χ^(2)=3.68,P=0.885);列线图模型校正曲线趋近于理想曲线,两者平均绝对误差为0.012;ROC曲线下面积为0.945,95%CI为0.918~0.972,灵敏度为0.921,特异度为0.853,提示该模型具有较好的区分度及校准度。外部验证结果显示,该列线图预测服用复康宁胶囊TNBC-NAC后贫血的灵敏度为88.7%,特异度为85.45%,准确度为86.73%。结论绝经状态、RBC、化疗前Hb水平、病理分期是服用复康宁胶囊TNBC-NAC后贫血的独立危险因素,基于上述指标建立的列线图预测模型,具有较好的区分度、校准度,较准确预测TNBC-NAC后发生贫血的可能性。Objective To explore the risk factors analysis and validation of anemia after triple-negative breast cancer(TNBC)and risk prediction model,to provide reference for reducing the incidence of anemia after TNBC-NAC.Methods Retrospectively,316 female TNBC-NAC patients in the breast department of our hospital from January 2016 to July 2021 were selected as the study subjects(modeling set),and the condition of anemia after the last chemotherapy was set as the observation group.In addition,98 breast cancer patients in 2022 were selected for validation.Multivariate Logistic regression was used to analyze the effect of Fukangning capsule on TNBC-NAC anemia.We established the risk nomogram prediction model and calibration curve of anemia after chemotherapy by using R software and conducted internal and external verification.Hosmer-Lemeshow test was used to evaluate the prediction deviation between the risk prediction value of the nomogram model and the actual observed value,and the ROC curve was used to evaluate the prediction effect of the model.Results A total of 75(23.73%)among 316 patients developed anemia.The results of multivariate Logistic regression analysis showed that menopause[OR(95%CI)=26.739(5.063-141.227)],RBC[OR(95%CI)=0.168(0.098-0.286)],Hb level[OR(95%CI)=0.952(0.929-0.976)],and pathological stageⅢ[OR(95%CI)=4.182(1.759-9.946)]were independent risk factors for anemia after TNBC-NAC(P<0.05).The nomogram prediction model established based on the above factors.Hosmer-Lemeshow test results showed that the difference between the risk prediction value and the actual observed value is(χ^(2)=3.68,P=0.885).The correction curve approaches to the ideal curve and the average absolute error was 0.012.The area under the ROC curve was 0.945,95%CI was 0.918-0.972,sensitivity was 0.921 and specificity was 0.853,suggesting that the model has good differentiation and calibration degree.The external validation results showed that the nomogram predicted anemia with sensitivity of 88.7%,spectificity of 85.45%and accuracy of

关 键 词：乳腺肿瘤 贫血 复康宁胶囊 新辅助化疗 ROC曲线 

分 类 号：R273[医药卫生—中西医结合]