结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建  

Analysis of risk factors for metachronous liver metastases after radical colorectal cancer surgery and construction of a predictive model

作　　者：唐旭 韩冰[1] 刘威[1] 陈茹星 Tang Xu;Han Bing;Liu Wei;Chen Ruxing(Department of General Surgery,Jixi People's Hospital,Jixi Heilongjiang Province 158100,China;Heilongjiang University of Traditional Chinese Medicine,Harbin Heilongjiang Province 150006,China)

机构地区：[1]鸡西市人民医院普外科,黑龙江鸡西158100 [2]黑龙江中医药大学,哈尔滨150006

出　　处：《中华普外科手术学杂志（电子版）》2024年第1期16-20,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：黑龙江省中医药管理局科研项目(2020-064)。

摘　　要：目的探讨影响结直肠癌根治术后隐匿性肝转移的危险因素及其预测模型的构建价值。方法回顾性分析2018年6月至2022年6月期间130例实施结直肠癌根治术患者的临床资料,根据患者随访期间是否发生隐匿性肝转移分为转移组(n=30例)和未转移组(n=100例)。使用SPSS 26.0统计学软件进行数据分析,采用单因素及多因素Logistic回归分析影响结直肠癌根治术后隐匿性肝转移发生的危险因素,应用独立危险因素构建列线图预测模型。绘制受试者工作特征曲线(ROC)评价列线图预测模型的区分度,验证预测列线图模型的一致性。检验标准取双侧α=0.05。结果130例患者隐匿性肝转移发生率为23.1%。转移组患者术前癌胚抗原(CEA)≥5μg/L、周围神经侵犯、低分化、血管侵犯、肿瘤最长径≥5 cm、T3-4期、N1-2期占比高于未转移组,差异有统计学意义(P<0.05);多因素Logistic回归分析显示除术前CEA≥5μg/L外,其余均为影响结直肠癌根治术后隐匿性肝转移发生的危险因素(P<0.05)。构建结直肠癌根治术后隐匿性肝转移列线图预测模型,周围神经侵犯、低分化、血管侵犯、肿瘤最长径≥5 cm、T3-4期、N1-2期的得分分别为48分、68分、88分、60分、12分、100分,各项因素总分之和对应隐匿性肝转移发生概率,绘制ROC曲线的曲线下面积(AUC)为0.768(95%CI:0.672-0.864)。校准曲线显示,结直肠癌根治术后列线图模型预测隐匿性肝转移发生概率与实际发生概率具有良好的一致性(P>0.05)。结论周围神经侵犯、低分化、血管侵犯、肿瘤最长径≥5 cm、T3-4期、N1-2期均为结直肠癌根治术后隐匿性肝转移发生的独立危险因素,以上述各因素构建列线图预测模型对结直肠癌根治术后隐匿性肝转移的发生有较高的预测效能。Objective To investigate the risk factors of metachronous liver metastases after radical resection of colorectal cancer and the value of building a prediction model.Methods The clinical data of 130 patients who underwent radical colorectal cancer treatment during the period from June 2018 to June 2022 were retrospectively analysed.Patients were divided into metastatic group(30 cases)and non-metastatic group(100 cases)according to whether occult liver metastasis occurred during follow-up.SPSS 26.0 software was used for data analysis,single factor and multiple factor Logistic regression were used to analyze the risk factors affecting the occurrence of occulted liver metastases after radical resection of colorectal cancer,and independent risk factors were used to build a nomogram prediction model.Receiver operating characteristic curve(ROC)was drawn to evaluate the differentiation of the prediction model and verify the consistency of the prediction model.Takeα=0.05 on both sides.Results The incidence of occult liver metastasis was 23.1%in 130 patients.Preoperative CEA≥5μg/L,peripheral nerve invasion,low differentiation,vascular invasion,longest tumor diameter≥5 cm,stage T3-4 and stage N1-2 in metastasis group were higher than those in non-metastatic group,and the differences were statistically significant(P<0.05).Multiple Logistic regression analysis showed that CEA≥5μg/L before surgery was the risk factor for metachronous liver metastasis after radical resection of colorectal cancer(P<0.05).The prediction model of metachronous liver metastases after radical resection of colorectal cancer was established.The scores of peripheral nerve invasion,low differentiation,vascular invasion,longest tumor diameter≥5 cm,stage T3-4 and stage N1-2 were 48,68,88,60,12 and 100,respectively.The total score of each factor corresponds to the probability of occurrence of metachronous liver metastasis.The area under the curve(AUC)of ROC curve was 0.768(95%CI:0.672-0.864).The calibration curve showed that the probability of me

关 键 词：结直肠肿瘤 异时性肝转移 危险因素 预测模型 列线图 

分 类 号：R735.34[医药卫生—肿瘤]