胰腺导管腺癌行腹腔镜下胰十二指肠切除术后早期复发的列线图模型及其预测价值分析  

Value of a nomogram model in early recurrence of pancreatic ductal adenocarcinoma after laparoscopic pancreaticoduodenectomy

作　　者：刘舜 谢诚 刘亚辉[1] LIU Shun;XIE Cheng;LIU Yahui(Second Department of Hepatobiliary Surgery,Center for General Surgery,The First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院普通外科中心肝胆胰外二科,长春130021

出　　处：《临床肝胆病杂志》2024年第1期138-146,共9页Journal of Clinical Hepatology

摘　　要：目的探究胰腺导管腺癌(PDAC)患者行腹腔镜胰十二指肠切除术(LPD)后肿瘤早期复发的危险因素并建立预测模型。方法回顾性分析2016年4月—2022年7月于吉林大学第一医院行LPD的240例PDAC患者的临床资料,以术后肿瘤早期复发(复发时间≤12个月)为研究结局。按照7∶3比例,随机将患者分为训练组(n=168)与验证组(n=72)。训练组术后早期复发70例(41.67%),非早期复发98例(58.33%)。验证组术后早期复发32例(44.44%),非早期复发40例(55.56%)。计数资料组间比较采用χ^(2)检验或Fisher精确概率法。Logistic回归分析影响术后早期复发的危险因素。采用受试者工作特征曲线下面积(AUC)评估模型的区分度,AUC>0.75为该模型有足够的区分度。用Bootstrap重采样法随机抽样1000次验证,并用验证组再次验证。使用校准曲线和Hosmer-Lemeshow拟合优度检验评估校准度,决策曲线评估临床实用性。结果单因素、多因素分析结果显示:术前CA19-9水平≥37 U/mL、肿瘤最大直径>3 cm、肿瘤低分化、有淋巴结转移、术后未行辅助化疗是影响PDAC行LPD术后早期复发的独立危险因素[OR(95%CI)分别为6.265(1.938~20.249)、10.878(4.090~28.932)、3.679(1.435~9.433)、0.209(0.080~0.551)、0.167(0.058~0.480),P值均<0.05]。以此为基础构建列线图模型,AUC=0.895(95%CI:0.846~0.943,P<0.001),校准曲线Hosmer-Lemeshow检验表明模型具有良好的校准度(P=0.173)。决策曲线显示列线图具有良好的临床应用价值。结论术前CA19-9水平≥37 U/mL、肿瘤最大直径>3 cm、肿瘤低分化、有淋巴结转移、术后未行辅助化疗是影响PDAC LPD术后早期复发的独立危险因素,以此为依据构建列线图模型可有效预测术后早期复发。Objective To investigate the risk factors for early tumor recurrence after laparoscopic pancreaticoduodenectomy(LPD)in patients with pancreatic ductal adenocarcinoma(PDAC),and to establish a predictive model.Methods A retrospective analysis was performed for the clinical data of 240 PDAC patients who underwent LPD in The First Hospital of Jilin University from April 2016 to July 2022,with early postoperative tumor recurrence(time to recurrence≤12 months)as the study outcome.The patients were randomly divided into training group with 168 patients and validation group with 72 patients at a ratio of 7∶3.In the training group,there were 70 patients(41.67%)with early postoperative recurrence and 98(58.33%)without early recurrence,and in the validation group,there were 32(44.44%)with early postoperative recurrence and 40(55.56%)without early recurrence.The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups;a logistic regression analysis was used to investigate the risk factors for early postoperative recurrence;the receiver operating characteristic(ROC)curve and the area under the ROC curve(AUC)were used to evaluate the discriminatory ability of the model,with AUC>0.75 indicating that the model had adequate discriminatory ability.The Bootstrap resampling method was used for validation after 1000 times of random sampling,and the model was validated again in the validation group.The calibration curve and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the degree of calibration,and the decision curve analysis was used to evaluate clinical practicability.Results The univariate and multivariate analyses showed that preoperative CA19-9 level≥37 U/mL(odds ratio[OR]=6.265,95%confidence interval[CI]:1.938-20.249,P<0.05),maximum tumor diameter>3 cm(OR=10.878,95%CI:4.090-28.932,P<0.05),poor tumor differentiation(OR=3.679,95%CI:1.435-9.433,P<0.05),lymph node metastasis(OR=0.209,95%CI:0.080-0.551,P<0.05),and absence of adjuvant chemotherapy after surgery(OR=0

关 键 词：胰腺导管腺癌 胰十二指肠切除术 肿瘤复发 局部 

分 类 号：R735.9[医药卫生—肿瘤]