复发高级别脑胶质瘤患者伽玛刀放疗预后危险因素及风险预测模型构建  

Risk Factors for the Prognosis of Recurrent High-Grade Glioma Patients Undergoing Gamma Knife Radiotherapy and Construction of Risk Prediction Models

作　　者：秦德华[1] 卜亚静 时昌立 安全[1] 梁武龙 QIN Dehua;BU Yajing;SHI Changli;AN Quan;LIANG Wulong(Gamma Knife Department,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]郑州大学第五附属医院伽马刀科,河南郑州450003

出　　处：《河南医学研究》2024年第8期1388-1392,共5页Henan Medical Research

基　　金：2021年度河南省医学科技攻关计划(LHGJ20210487)。

摘　　要：目的分析复发高级别脑胶质瘤患者伽玛刀放疗预后的危险因素,并构建风险预测模型。方法回顾性收集2019年1月至2022年1月于医院接受伽玛刀放疗的85例复发高级别脑胶质瘤患者临床资料,依据随访1 a期间预后情况将资料分为病死组(n=40)与存活组(n=45)。采用Cox回归分析影响复发高级别脑胶质瘤患者伽玛刀放疗预后的因素,根据回归分析结果构建风险预测模型,利用R软件构建列线图,并绘制受试者工作特征曲线评估风险模型的预测效能。结果病死组年龄、最大肿瘤直径大于存活组,而靶区周边剂量、放疗前Karnofsky功能状态(KPS)评分低于存活组,差异有统计学意义(P<0.05);经Cox回归分析显示,年龄、最大肿瘤直径为复发高级别脑胶质瘤患者伽玛刀放疗后病死的危险因素(HR>1,P<0.05),而靶区周边剂量、放疗前KPS评分为复发高级别脑胶质瘤患者伽玛刀放疗后病死的保护因素(HR<1,P<0.05);绘制列线图构建复发高级别脑胶质瘤患者伽玛刀放疗预后病死风险预测模型,验证模型区分度显示一致性指数(C-index)值=0.876,具有良好的区分度;绘制标准曲线显示,校准曲线与Y-X直线相近,模型准确度良好。结论年龄、靶区周边剂量、最大肿瘤直径、KPS评分为复发高级别脑胶质瘤患者伽玛刀放疗预后的影响因素,基于以上因素构建的风险模型对于复发高级别脑胶质瘤患者伽玛刀放疗预后的预测价值较高,具有良好的临床应用价值。Objective To analyze the risk factors for the prognosis of recurrent high-grade glioma patients undergoing gamma knife radiotherapy and construct a risk prediction model.Methods A retrospective collection of clinical data was conducted on 85 patients with recurrent high-grade glioma who underwent gamma knife radiotherapy at the hospital from January 2019 to January 2022.The data were divided into a mortality group(40 cases)and a survival group(45 cases)based on the prognosis during the one year follow-up period.Cox regression analysis was used to analyze the factors that affect the prognosis of patients with recurrent high-grade glioma undergoing gamma knife radiotherapy.A risk prediction model was constructed based on the regression analysis results,and a column chart was constructed using R software.The predictive efficacy of the risk model was evaluated by plotting the receiver operating characteristic curve.Results The age and maximum tumor diameter of the mortality group were larger than those of the survival group,while the peripheral dose of the target area and Karnofsky functional state(KPS)score before radiotherapy were lower than those of the survival group,with statistical significant differences(P<0.05).Cox regression analysis showed that age and maximum tumor diameter were risk factors for mortality after gamma knife radiotherapy in patients with recurrent high-grade gliomas(HR>1,P<0.05),while peripheral dose to the target area and pre radiotherapy KPS score were protective factors for mortality after gamma knife radiotherapy in patients with recurrent high-grade gliomas(HR<1,P<0.05).A nomogram was drawn to construct a prognostic risk prediction model for gamma knife radiotherapy in patients with recurrent high-grade glioma.The model discrimination showed a consistency index(C-index)value of 0.876,with good discrimination.The standard curve showed that the calibration curve was close to the Y-X straight line,and the accuracy of the model was good.Conclusion Age,peripheral dose to the target area,maxi

关 键 词：高级别脑胶质瘤 复发 伽玛刀放疗 预后 影响因素 风险预测模型 

分 类 号：R651.1[医药卫生—外科学]