接受NSS治疗的早期肾细胞癌患者术后MIC综合结局影响因素分析及预测模型构建  

Influencing factors analysis and prediction model construction of postoperative MIC comprehensive outcome in patients with early renal cell carcinoma treated with NSS

作　　者：李升平 石永柱 马锋 Li Shengping;Shi Yongzhu;Ma Feng(Department of Urology Surgery,3201 Hospital,Hanzhong 723000,China)

机构地区：[1]三二〇一医院泌尿外科,汉中723000

出　　处：《国际肿瘤学杂志》2023年第12期723-728,共6页Journal of International Oncology

摘　　要：目的探讨接受保留肾单位手术(NSS)治疗的T1b期肾细胞癌患者术后手术切缘、热缺血时间联合术后严重并发症(MIC)综合结局影响因素并构建预测模型。方法选取2017年1月至2022年1月于三二〇一医院接受NSS治疗的T1b期肾细胞癌患者174例为研究对象,根据术后是否实现MIC综合结局,将患者分为MIC组(n=66)和非MIC组(n=108)。采用单因素和多因素分析患者术后MIC综合结局的独立影响因素,根据影响因素构建列线图预测模型并采用受试者操作特征(ROC)曲线评估该模型的预测价值。结果MIC组和非MIC组患者体质量指数(t=2.81,P=0.006)、病灶形态学(χ^(2)=41.41,P<0.001)、热缺血时间(t=16.92,P<0.001)、术后24 h内肌酐升高值(t=16.79,P<0.001)、术后24 h内血红蛋白(Hb)下降值(t=9.33,P<0.001)、围手术期并发症(χ^(2)=21.31,P<0.001)、R.E.N.A.L.评分(t=4.74,P<0.001)、PADUA评分(t=3.21,P=0.002)及梅奥肾周粘连指数(t=22.28,P<0.001)比较,差异均有统计学意义。多因素分析显示,体质量指数(OR=0.31,95%CI为0.13~0.74,P=0.007)、病灶形态学(OR=0.36,95%CI为0.22~0.59,P<0.001)、PADUA评分(OR=0.37,95%CI为0.17~0.81,P=0.013)及梅奥肾周粘连指数(OR=0.43,95%CI为0.24~0.70,P=0.004)均是接受NSS治疗的T1b期肾细胞癌患者术后MIC综合结局的独立影响因素。根据筛选出的变量所构建的列线图模型的C-index为0.89,具有较高的预测准确性;曲线下面积(AUC)为0.84(95%CI为0.77~0.91),具有良好的预测效能。结论体质量指数、病灶形态学、PADUA评分及梅奥肾周粘连指数均为接受NSS治疗的T1b期肾细胞癌患者术后能否实现MIC综合结局的独立影响因素,以此构建的列线图模型具有较高的预测准确性。Objective To investigate the influencing factors of postoperative surgical margin,warm ischemia time and severe postoperative complication(MIC)comprehensive outcome in patients with stage T1b renal cell carcinoma treated with nephron sparing surgery(NSS)and to establish a predictive model.Methods One hundred and seventy-four patients with stage T1b renal cell carcinoma treated with NSS were retrospectively chosen in the period from January 2017 to January 2022 in 3201 Hospital.All patients were divided into MIC group(n=66)and non-MIC group(n=108)according to whether MIC was achieved after surgery or not.Univariate and multivariate analysis were used to evaluate the independent influencing factors of postoperative MIC comprehensive outcome,and a nomogram prediction model was constructed according to the influencing factors and its predictive value was evaluated using receiver operating characteristic(ROC)curve.Results There were statistically significant differences in the body mass index(t=2.81,P=0.006),lesion morphology(χ^(2)=41.41,P<0.001),hot ischemia time(t=16.92,P<0.001),creatinine increase within 24 h after surgery(t=16.79,P<0.001),hemoglobin(Hb)decreased within 24 h after surgery(t=9.33,P<0.001),perioperative complications(χ^(2)=21.31,P<0.001),R.E.N.A.L.score(t=4.74,P<0.001),PADUA score(t=3.21,P=0.002)and Mayo perirenal adhesion index(t=22.28,P<0.001)in MIC group and non-MIC group.Multivariate analysis showed that body mass index(OR=0.31,95%CI:0.13-0.74,P=0.007),lesion morphology(OR=0.36,95%CI:0.22-0.59,P<0.001),PADUA score(OR=0.37,95%CI:0.17-0.81,P=0.013)and Mayo perirenal adhesion index(OR=0.43,95%CI:0.24-0.70,P=0.004)were all independent factors of postoperative MIC comprehensive outcomes in patients with stage T1b renal cell carcinoma treated with NSS.The C-index of the nomogram model built according to the selected variables was 0.89 with high prediction accuracy;area under the curve(AUC)was 0.84(95%CI:0.77-0.91),and it had good predictive performance.Conclusion Body mass index,lesion morphology,PAD

关 键 词：癌 肾细胞 肾切除术 切缘 热缺血 手术后并发症 

分 类 号：R737.11[医药卫生—肿瘤]