非小细胞肺癌袖状肺叶切除术最佳时机相关危险因素及其预测模型构建  

Developing a nomogram for predicting optimal non-small cell lung cancer patients for sleeve lobectomy and its implications on prognosis

作　　者：许广辉[1] 丁成智[1] 宋静超[1] 姜功前[1] 王洪涛[1] 吴振江[1] 王国磊[1] XU Guang-hui;DING Cheng-zhi;SONG Jing-chao;JIANG Gong-qian;WANG Hong-tao;WU Zhen-jiang;WANG Guo-Lei(Department of Thoracic Oncology,Henan Provincial Chest Hospital,Chest Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院胸部肿瘤科,郑州大学附属胸科医院,郑州450000

出　　处：《医药论坛杂志》2023年第24期1-8,共8页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190747)。

摘　　要：目的基于袖状肺叶切除术患者的临床数据,开发一种用于预测最优袖状肺叶切除术的列线图模型。方法收集2010年2月至2018年2月期间在河南省胸科医院接受袖状叶切除术的575例患者,其中118例患者被排除在外。预测列线图基于Cox回归模型分析确定独立风险因素。根据模型中获得的风险评分,使用受试者操作特征(ROC)和Kaplan-Meier曲线将患者分为两个风险层。结果总生存期(OS)和无复发生存期(RFS)分别为60.1%和73.9%。复发组和非复发组之间的基线特征无显著差异。术后最常见的并发症是酸碱紊乱,其次是肺不张/气胸和低氧血症。多变量Cox回归分析表明,年龄、新辅助治疗、上腔静脉浸润、肿瘤大小和淋巴结分期是预后的独立危险因素。另一方面,年龄、住院时间、切缘状态、肿瘤大小、淋巴结分期和切除淋巴结总数与RFS独立相关。根据列线图中的风险评分,发现RFS中高风险和低风险患者的临界值为161.9282,OS中为159.5821。结论这项研究确定了袖状肺叶切除术后生存和复发的一些关键危险因素,有助于评估手术前风险,并指导外科医生确定袖状肺叶切除术的最佳获益患者。Objective Sleeve lobectomy has been widely recognized as an alternative surgical technique for pneumonectomy since it can preserve most of the pulmonary parenchyma.This study aimed at developing a nomogram for predicting the opti⁃mal patients for sleeve lobectomy.Methods In this retrospective cohort study,we collected 575 patients who underwent sleeve lobectomy at the Henan Chest Hospital from Feb.2012 to Feb.2022,of which 118 patients were excluded.The predic⁃tive nomogram was based on the independent risk factors identified by Cox regression analysis.According to the risk scores acquired from the model,we classified the patients into two risk strata using receiver operating characteristics(ROC)and Ka⁃plan-Meier curves.Results The overall survival(OS)and recurrence-free survival(RFS)were 60.1%and 73.9%,re⁃spectively.There was no significant difference in baseline characteristics between the recurrence and non-recurrence groups.The most frequent complication after surgery was acid-base disturbance,followed by atelectasis/pneumothorax and hypox⁃emia.Multivariable Cox regression analysis demonstrated that age at diagnosis,neoadjuvant therapy,superior vena cava inva⁃sion,tumor size,and N-stage were the independent risk factors for OS.On the other hand,age at diagnosis,in-hospital duration,margin status,tumor size,N-stage,and the total number of resected nodes were independently correlated with RFS.According to the risk scores in the nomogram,it was found that the cutoff between high-risk and low-risk patients was 161.9282 in RFS and 159.5821 in OS.Conclusion This study identified some crucial risk factors of survival and recur⁃rence after sleeve lobectomy which were associated with prognosis.This predictive model may aid in evaluating the post-op⁃erative risks before surgery and guide surgeons in identifying the optimal patients for sleeve lobectomy.

关 键 词：袖状肺叶切除术 非小细胞肺癌 外科手术 术后预测 

分 类 号：R734.2[医药卫生—肿瘤]