Ⅰ-ⅡA期肺腺癌根治术后复发转移危险因素分析及预测模型构建  

Risk factors analysis and prediction model construction of recurrence and metastasis of stageⅠ-ⅡA lung adenocarcinoma after radical operation

作　　者：唐兴华 吴婧文 韩利会 杨秋安[1] 薛玉文[2] TANG Xinghua;WU Jingwen;HAN Lihui;YANG Qiuan;XUE Yuwen(Department of Radiation Oncology,Qilu Hospital of Shandong University,Jinan 250012,China;不详)

机构地区：[1]山东大学齐鲁医院肿瘤放疗科,济南250012 [2]山东大学齐鲁医院呼吸与危重症医学科

出　　处：《山东医药》2023年第21期20-24,共5页Shandong Medical Journal

摘　　要：目的分析Ⅰ-ⅡA期肺腺癌根治术后复发转移的危险因素,构建Ⅰ-ⅡA期肺腺癌根治术后复发转移的预测模型。方法行肺癌根治术并经病理确诊为Ⅰ-ⅡA期LUAD患者205例,收集患者的临床资料,包括性别、年龄、吸烟史、术前肺功能、肿瘤位置、肿瘤最大直径、淋巴结清扫数目、术后病理见微乳头结构、胸膜侵犯、脉管癌栓、辅助化疗情况、术前血清癌胚抗原(CEA)水平、术前中性粒细胞计数与淋巴细胞比值(NLR)、术前预后营养指数(PNI),统计患者术后复发转移情况;采用Kaplan-Meier法绘制生存曲线,联合log-rank法分析Ⅰ-ⅡA期LUAD术后复发转移的相关因素;采用COX比例风险模型分析Ⅰ-ⅡA期LUAD术后复发转移的独立危险因素。使用R语言软件构建Ⅰ-ⅡA期LUAD根治术后复发转移风险预测列线图。采用Bootstrap法对列线图进行内部验证,计算该列线图的C-index值;绘制列线图的ROC曲线,评价列线图的区分度;采用校准曲线评价列线图的一致性。结果肿瘤最大直径、术后病理见微乳头结构、术前肺功能、术前血清CEA水平、术前NLR、术前PNI与Ⅰ-ⅡA期LUAD根治术后复发转移有关(P均<0.05),其中肿瘤最大直径>3 cm、术前血清CEA>5 ng/mL、术前NLR>2.285、术前PNI≤46.625是Ⅰ-ⅡA期LUAD根治术后复发转移的独立危险因素(P均<0.05)。构建了Ⅰ-ⅡA期LUAD根治术后复发转移风险预测列线图。列线图的C-index值为0.814(95%CI为0.751~0.877),该列线图预测Ⅰ-ⅡA期LUAD根治术后2年、3年、5年复发转移的ROC的AUC分别为0.757(95%CI为0.641~0.874)、0.696(95%CI为0.595~0.797)、0.675(95%CI为0.589~0.762),Ⅰ-ⅡA期LUAD根治术后复发转移风险预测列线图的校准曲线均接近参考线。结论Ⅰ-ⅡA期LUAD根治术后复发转移的独立危险因素为肿瘤最大直径>3 cm、术前血清CEA>5 ng/mL、术前NLR>2.285、术前PNI≤46.625。成功构建了Ⅰ-ⅡA期LUAD根治术后复发转移风�Objective To analyze the risk factors for postoperative recurrence and metastasis of stage I-IIA lung adenocarcinoma(LUAD),and to construct a risk prediction model for postoperative recurrence and metastasis of stage I-IIA lung adenocarcinoma.Methods A total of 205 patients with stage I-IIA LUAD diagnosed pathologically after radical operation of lung cancer were included.We collected the clinical data of patients,including gender,age,smoking history,preoperative lung function,tumor location,maximum tumor diameter,the number of lymph nodes dissection,postoperative pathology containing micropapillary structure,pleural invasion,vascular thrombus,adjuvant chemotherapy,preoperative serum carcinoembryonic antigen(CEA)level,preoperative neutrophil count to lymphocyte ratio(NLR),and preoperative prognostic nutrition index(PNI).The postoperative recurrence and metastasis of patients were analyzed.Kaplan-Meier method was used to draw the survival curve,and log-rank method was used to analyze the related factors of postoperative recurrence and metastasis of stage I-IIA LUAD.COX proportional risk model was used to analyze the independent risk factors for postoperative recurrence and metastasis of stage I-IIA LUAD.The R Programming Language was used to construct the prediction nomogram of recurrence and metastasis risk after radical operation of stage I-IIA LUAD.Bootstrap method was used to verify the nomogram internally,and C-index value of the nomogram was calculated.ROC curve of the nomogram was drawn to evaluate the discrimination of the nomogram.Calibration curve was used to evaluate the consistency of the nomogram.Results The maximum tumor diameter,postoperative pathology containing micropapillary structure,preoperative lung function,preoperative serum CEA level,preoperative NLR,and preoperative PNI were related to the recurrence and metastasis of stage I-IIA LUAD after radical operation(all P<0.05).Among them,the maximum tumor diameter>3 cm,preoperative serum CEA>5 ng/mL,preoperative NLR>2.285,and preoperative PNI≤4

关 键 词：肺癌术后复发 肺癌术后转移 肺腺癌 Ⅰ期肺腺癌 ⅡA期肺腺癌 肺癌复发预测模型 肺癌转移预测模型 列线图 

分 类 号：R734.2[医药卫生—肿瘤]