胃癌异时性肝转移的危险因素分析及预测模型的建立  

Analysis of risk factors and establishment of nomogram for predicting metachronous liver metastasis of gastric cancer

作　　者：巨家华 王朝樣 张海宝[1] 林浩 俞永江[2] JU Jiahua;WANG Chaoyang;ZHANG Haibao;LIN Hao;YU Yongjiang(The First Clinical Medical College of Lanzhou University,Lanzhou 730000,P.R.China;Department of Gastrointestinal and Hernia and Abdominal Wall Surgery,The First Hospital of Lanzhou Univerity,Lanzhou 730000,P.R.China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院胃肠及疝与腹壁外科,兰州730000

出　　处：《中国普外基础与临床杂志》2023年第9期1073-1078,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：甘肃省自然科学基金(项目编号:21JR1RA075)。

摘　　要：目的探讨胃癌根治性切除术后发生异时性肝转移的危险因素并建立对它的预测模型。方法回顾性收集行胃癌根治性切除术且符合本研究制定的纳入和排除标准患者,来源于兰州大学第一医院2015年1月1日至2018年1月1日期间的患者。采用单因素和多因素logistic回归分析筛选出影响胃癌异时性肝转移发生的风险因素,同时以这些风险因素构建列线图预测模型并评估其预测效能。结果本研究共纳入了符合研究条件的患者203例,其中有41例(20.4%)出现胃癌异时性肝转移。经多因素logistic回归分析结果显示,癌胚抗原≥5μg/L、术中失血量、肿瘤直径≥5 cm、有脉管神经侵犯这4个因素增加胃癌异时性肝转移发生的风险(P<0.05)。基于这4个风险因素构建的列线图预测模型区分胃癌异时性肝转移是否发生的受试者操作特征曲线下面积及其95%可信区间(95%confidence interval,95%CI)为0.850(0.793,0.908),一致性指数(95%CI)为0.812(0.763,0.859)。列线图预测胃癌异时性肝转移发生风险与实际发生风险的校准曲线接近45°理想曲线,吻合程度较好(HosmerLemeshow拟合优度检验,χ^(2)=2.116,P=0.347)。结论本研究结果得出,胃癌根治性切除术后异时性肝转移发生率不低,存在淋巴血管侵犯、癌胚抗原水平高(≥5μg/L)、术中失血量增多、肿瘤直径(≥5 cm)的患者胃癌异时性肝转移发生的风险更高,基于这些风险因素建立的列线图预测模型对此预测效能良好,可为临床医生识别高风险患者并尽早采取干预措施提供一定的参考。Objective To investigate the risk factors and establish the predictive pattern of the metachronous liver metastasis after curative surgery for patients with gastric cancer.Methods The clinicopathologic data of patients who underwent radical gastric cancer surgery and met the inclusion and exclusion criteria from January 1,2015 and January 1,2018 in the First Hospital of Lanzhou University were retrospectively analyzed.The risk factors affecting metachronous liver metastasis of gastric cancer were screened out by univariate and multivariate logistic regression analysis.And a nomogram prediction model based on the risk factors screened out was established and its predictive efficiency was evaluated.Results A total of 203 patients were collected in this study,of whom 41(20.4%)developed metachronous liver metastasis of gastric cancer.The results of multivariate logistic regression analysis showed that the tumor diameter≥5 cm,increasing intraoperative bleeding,carcinoembryonic antigen(CEA)≥5μg/L,and lymphovascular invasion increased the risks of metachronous liver metastasis of gastric cancer(all P<0.05).The area under the receiver operating characteristic curve and its 95%confidence interval(95%CI)of the nomogram based on these risk factors in predicting metachronous liver metastasis of gastric cancer was 0.850(0.793,0.908),and the consistency index(95%CI)was 0.812(0.763,0.859).The calibration curve for predicting the risk of metachronous liver metastasis in gastric cancer by the nomogram was close to the 45°ideal curve and had a stronger calibration(Hosmer Limeshow goodness-of-fit test,χ^(2)=2.116,P=0.347).Conclusions The results of this study conclude metachronous liver metastasis of gastric cancer is not low,and the patient with lymphovascular invasion,higher level of CEA(≥5μg/L),more intraoperative bleeding,and larger tumor diameter(≥5 cm)has a higher risk of metachronous liver metastasis of gastric cancer.The nomogram prediction model established based on these risk factors has a good predictive effi

关 键 词：胃癌 根治性手术 异时性肝转移 列线图 

分 类 号：R735.2[医药卫生—肿瘤]