用于预测非肌层浸润膀胱癌肿瘤切除术后复发的列线图模型  

A nomogram model for predicting the recurrence of non⁃muscle⁃invasive bladder cancer after tumor resection

作　　者：孙健瑄 安晔 徐梦瑶 刘晨茜 徐金洲 王少刚[1] SUN Jianxuan;AN Ye;XU Mengyao;LIU Chenqian;XU Jinzhou;WANG Shaogang(Department and Institute of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《广州医科大学学报》2023年第3期6-12,共7页Academic Journal of Guangzhou Medical University

摘　　要：目的:探讨非肌层浸润膀胱癌患者术后复发的预测因子,并构建列线图预测模型。方法:回顾性收集本院90例中危或高危非肌层浸润膀胱癌患者的临床资料,所有患者均接受传统经尿道膀胱肿瘤切除术(TURBT)或铥激光膀胱肿瘤切除术(TmLRBT)并进行了膀胱内卡介苗灌注;采用单因素和多因素logistic回归筛选独立预测因素并建立列线图模型。结果:多因素logistic回归显示手术方式(TmLRBT vsTURBT)、既往膀胱肿瘤史和卡介苗灌注治疗次数是非肌层浸润患者术后复发的独立预测因素,列线图显示C指数为0.947,ROC曲线显示曲线下面积(AUC)为0.861。校准曲线和理想曲线贴合良好,决策曲线显示风险阈值为0.0~0.58和0.76~0.96时列线图的预测效能最好。结论:接受TmLRBT、没有膀胱肿瘤史并且接受卡介苗灌注次数更多的非肌层浸润膀胱癌患者倾向于更低的术后复发率,列线图可以在早期预测该类患者术后膀胱内卡介苗灌注后的复发情况,有助于进行临床决策和早期干预。Objective:To explore the predictive factors of recurrence for non-muscle-invasive bladder cancer(NMIBC)patients after tumor resection and construct a predictive nomogram model.Methods:We retrospectively collected 90 patients who were diagnosed as intermediate-or high-risk NMIBC and received a Thulium laser resection of bladder tumor(TmLRBT)or transurethral resection of bladder tumor(TURBT)followed by BCG instillation.Univariate logistic regression was used to screen the predictors related to recurrence,and then the independent predictors were screened by multivariate logistic regression analysis.The nomogram model was established according to the obtained independent predictive factors.Results:Multivariate logistic regression analysis showed that the surgery type(TmLRBT vs TURBT),the history of bladder tumor and the number of BCG therapy were independent predictors of postoperative recurrence in patients with NMIBC.The nomogram we constructed shows good prediction capability.The C index of the nomogram is 0.947,and the ROC curve shows that the area under the curve(AUC)of our prediction model is 0.861.The calibration curve and ideal curve fit well,and the decision curve analysis shows that our nomogram has the best predictive performance when the risk threshold is 0.0-0.58,0.76-0.96.Conclusion:Patients who received TmLRBT,without previous bladder tumor and received more BCG therapy tended to have lower risk of postoperative recurrence.The nomogram we constructed could predict the recurrence of NMIBC patients at an early stage,and cloud help urologists make clinical decisions and early interventions.

关 键 词：非肌层浸润性膀胱肿瘤 卡介苗 经尿道膀胱切除术 列线图 

分 类 号：R737.14[医药卫生—肿瘤]