Ⅰ期胃癌患者术后辅助化疗危险因素探究及列线图模型的建立  

Exploration of risk factors and establishment of nomograms model for postoperative adjuvant chemotherapy in stageⅠgastric cancer

作　　者：李力 高云鹤[2] 张奔龙 王子健 宋奇赢 崔昊 乔治[2] 陈凛[2] Li Li;Gao Yunhe;Zhang Benlong;Wang Zijian;Song Qiying;Cui Hao;Qiao Zhi;Chen Lin(Chinese PLA Medical School,Beijing 100853,China;Department of General Surgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心普通外科医学部,北京100853

出　　处：《国际外科学杂志》2023年第5期306-311,I0004,共7页International Journal of Surgery

基　　金：国家自然科学基金面上项目(81972790)。

摘　　要：目的探究Ⅰ期胃癌患者术后接受辅助化疗的相关危险因素,并建立基于危险因素的列线图(Nomograms)模型。方法采用回顾性病例对照研究的方法,收集2020年1月—12月于解放军总医院第一医学中心普通外科医学部行胃癌手术治疗的161例Ⅰ期原发性胃腺癌患者的病例资料,包括男性129例,女性32例,平均年龄(59.90±0.80)岁,其中术后辅助化疗41例(化疗组),未行术后辅助化疗120例(未化疗组)。采用单因素及多因素Logistic回归方法筛选Ⅰ期胃癌患者术后接受辅助化疗的危险因素并构建列线图模型。通过受试者工作特征曲线(ROC)及曲线下面积(AUC)和校准曲线对列线图模型的性能进行评价。结果多因素分析结果显示,肿瘤部位、肿瘤最大径、T分期、N分期、脉管癌栓或神经浸润是Ⅰ期胃癌术后辅助化疗的独立危险因素(P<0.05)。ROC曲线结果提示,AUC为0.91(95%CI:0.86~0.97),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-index为0.91)。结论肿瘤位于近端、肿瘤直径>2 cm、T2期、N1期、存在脉管癌栓或神经浸润可能是影响Ⅰ期胃癌患者化疗决策的独立危险因素。建立的列线图模型对于预测Ⅰ期胃癌患者术后化疗具有良好的预测能力,可为该部分患者的临床决策的选择提供参考。Objective To identify the risk factors associated with postoperative adjuvant chemotherapy in patients with stage I gastric cancer and establish nomograms model based on risk factors.Methods In this retrospective case-control study,161 cases with stageⅠprimary gastric adenocarcinoma were included who underwent gastrectomy at the Department of General Surgery of the First Medical Center of Chinese PLA General Hospital from January to December in 2020,including 129 male cases and 32 females cases,with the average age of(59.90±0.80)years.Among them,41 cases were treated with postoperative adjuvant chemotherapy(chemotherapy group),while 120 cases who did not receive postoperative adjuvant chemotherapy(no chemotherapy group).Univariate and multivariate Logistic regression analyses were used to identify the risk factors of adjuvant chemotherapy in stageⅠgastric cancer patients and establish the nomograms predictive model.ROC curve and calibration curve were used to evaluate the performance of the model.Results Multivariate analysis revealed that primary tumor site,tumor size,T stage,N stage lymph-vascular tumor embolus or perineural invasion were the independent risk factors of postoperative adjuvant chemotherapy for stageⅠgastric cancer(P<0.05).The ROC curve indicated that area under the curve(AUC)of the multivariate model was 0.91(95%CI:0.86-0.97).The calibration curve showed that probability predicted by nomograms was consistent with the actual situation(C-index:0.91).Conclusions The tumor located in the proximal stomach,tumor size>2 cm,T2,N1,lymph-vascular tumor embolus or perineural invasion maybe be the risk factors for chemotherapy decision in stageⅠgastric cancer patients.The established model has good predictive ability for postoperative chemotherapy of stageⅠgastric cancer patients,which might provide reference for the selection of clinical decisions in this part of patients.

关 键 词：胃肿瘤 化学疗法 辅助 危险因素 列线图 

分 类 号：R735.2[医药卫生—肿瘤]