胃癌术前淋巴结分期不足的危险因素及预测模型的建立  

Risk Factors and Establishment of Prediction Model for Preoperative Lymph Node Staging Deficiency in Gastric Cancer

作　　者：杜书祥 郭振[2] 陈紫来 王尚鑫 吴刚[3] DU Shuxiang;GUO Zhen;CHEN Zilai;WANG Shangxin;WU Gang(Department of Gastrointestinal Surgery,People’s Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Gastrointestinal Surgery,People’s Hospital of He'nan University,Zhengzhou 450003,China;Department of Gastrointestinal Surgery,He'nan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院胃肠外科,郑州450003 [2]河南大学人民医院胃肠外科,郑州450003 [3]河南省人民医院胃肠外科,郑州450003

出　　处：《肿瘤防治研究》2023年第5期498-504,共7页Cancer Research on Prevention and Treatment

基　　金：省部共建重点项目(SBGJ202102028)。

摘　　要：目的 分析胃癌术前淋巴结分期(N分期)不足的危险因素,建立术前评估模型,辅助预测术前N分期。方法 回顾性分析268例胃癌患者的临床病理资料。患者术前常规行薄层增强CT评估术前N分期,结合术后病理结果分析术前N分期不足的危险因素。Logistic回归分析筛选出的影响因素,Kaplan-Meier绘制术前N分期准确组与不足组的生存曲线,利用R软件包绘制Nomogram图、预测模型的ROC曲线,计算AUC、95%CI、敏感度和特异性。结果 年龄、BMI、低分化、Lauren分型为弥漫型是胃癌术前N分期不足的独立危险因素(P<0.05)。术前N分期不足组预后生存显著差于准确组(P=0.041)。预测模型的ROC曲线AUC为0.935,敏感度为85.9%,特异性为96.9%。结论 年龄越小、BMI越高、低分化、Lauren分型为弥漫型是术前N分期不足的独立危险因素。本研究基于年龄、BMI、分化程度、Lauren分型建立的术前N分期评估模型,具有较高的可信度。Objective To analyze the risk factors of preoperative lymph node staging(N-stage)deficiency in gastric cancer and establish a preoperative assessment model to assist in predicting preoperative N-stage.Methods A retrospective method was used to analyze the clinicopathological data of 268 patients with gastric cancer.The patients routinely underwent preoperative thin-section enhanced CT to assess preoperative N-stage.Results The risk factors for preoperative N-stage deficiency were analyzed in combination with postoperative pathological findings.Multifactorial logistic regression analysis was performed to determine influencing factors,and Kaplan-Meier analysis was used to plot the survival curves of preoperative N-stage accurate group and deficiency group.The nomogram plot and ROC curves of the prediction model were drawn using the R package.AUC,95%CI,sensitivity,and specificity were calculated.Results Age,BMI,poor differentiation,and Lauren’s classification as diffuse were independent risk factors for preoperative N-stage deficiency in gastric cancer(P<0.05).Prognostic survival was significantly worse in the preoperative N stageinadequate group than that in the accurate group(P=0.041).The AUC area was 0.935,with a sensitivity of 85.9%and specificity of 96.9%.Conclusion Young age,high BMI,poor differentiation,and Lauren’s classification as diffuse are independent risk factors for preoperative N-stage deficiency.The established preoperative assessment model based on age,BMI,differentiation degree,and Lauren’s classification in this study has relatively high credibility.

关 键 词：胃癌 薄层多期增强CT 术前N分期 危险因素 预测模型 

分 类 号：R735.2[医药卫生—肿瘤]