FUT7低甲基化和CT影像在肺浸润性腺癌中列线图预测模型的构建及评估  

Construction and evaluation of a nomogram prediction model for FUT7 hypomethylation and CT imaging in lung invasive adenocarcinoma

作　　者：黄玉阳 房怡菲 陈瑞英[1] 赵春玲[1] 张冰璐 代丽萍 欧阳松云[1] HUANG Yuyang;FANG Yifei;CHEN Ruiying;ZHAO Chunling;ZHANG Binglu;DAI Liping;OUYANG Songyun(Department of Respiratory,Critical Care and Sleep Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Henan Institute of Medical and Pharmaceutical Sciences,Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院呼吸与危重症睡眠医学科,河南郑州450052 [2]郑州大学河南省医药科学研究院,河南郑州450052

出　　处：《临床肺科杂志》2024年第6期811-817,共7页Journal of Clinical Pulmonary Medicine

摘　　要：目的 基于FUT7低甲基化和CT影像构建列线图模型预测肺浸润性腺癌(invasive adenocarcinoma cancer, IAC)发生的风险。方法 回顾性分析114例经术后病理确诊为肺腺癌和腺体前驱病变肺结节患者的临床和CT影像资料,检测其血液中FUT7甲基化水平。根据病理结果分为浸润性腺癌组和侵袭前病变组,采用单因素分析和多因素Logistic回归构建列线图模型。效能评价使用受试者工作特征曲线(receiver operator characteristic curve, ROC)、校准曲线(calibration curve)、决策曲线分析法(decision curve analysis, DCA)。结果 浸润性腺癌组组较侵袭前病变组FUT7_CpG_1和FUT7_CpG_4甲基化水平更低,肺窗最长径更大,结节形状更不规则,混杂磨玻璃结节、毛刺征、分叶征和胸膜征占比更高(P<0.05)。其中FUT7_CpG_1、肺窗最长径、结节性质(实性、混杂磨玻璃)和毛刺征是IAC的独立影响因素(P<0.05)。列线图模型的ROC曲线下面积为0.934(95%CI:0.889~0.979,P<0.001),最大约登指数对应的临界值为0.476,此时敏感度为93.24%,特异度为80.00%,阳性预测值为89.61%,阴性预测值为86.48%。校准曲线显示列线图预测IAC的概率与实际概率高度一致。DCA曲线显示阈概率值为0.06~0.80时,列线图具有较高的临床净收益。结论 血液中FUT7_CpG_1和FUT7_CpG_4低甲基化是诊断IAC的新型潜在生物标志物。列线图模型在早期识别IAC具有较高的诊断效能和应用价值,可以为临床医生决策提供理论参考。Objective To predict the risk of lung invasive adenocarcinoma(IAC)according to the nomogram model based on FUT7 hypomethylation and CT images.Methods The clinical and CT imaging data of 114 patients with lung adenocarcinoma and glandular precursor pulmonary nodules confirmed by postoperative pathology were retrospectively analyzed,and the FUT7 methylation level in their blood was detected.According to the pathological results,the patients were divided into the IAC group and the pre-invasive lesion group,and a nomogram model was constructed by univariate analysis and multivariate logistic regression.The performance was evaluated by receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results Compared with the pre-invasive lesion group,the methylation level of FUT7_CpG_1 and FUT7_CpG_4 was lower,the longest diameter of lung window was larger,the shape of nodule was more irregular,and the proportion of mixed ground glass nodule,spiculation sign,lobulation sign and pleural sign was higher in the IAC group(P<0.001).FUT7_CpG_1,the longest diameter of lung window,the nature of nodules(solid,mixed ground glass)and spiculation sign were independent imaging factors for IAC(P<0.05).The area under the ROC curve of the nomogram model was 0.934(95%CI:0.889-0.979,P<0.05).The critical value corresponding to the maximum Jordan index was 0.476,with a sensitivity of 93.24%,a specificity of 80.00%,a positive predictive value of 89.61%and a negative predictive value of 86.48%.The calibration curve showed that the probability of IAC predicted by the nomogram was highly consistent with the actual probability.The DCA curve showed that the nomogram had a higher clinical net benefit when the threshold probability was 0.06-0.80.Conclusion Hypomethylation of FUT7_CpG_1 and FUT7_CpG_4 in blood is a novel potential biomarker for the diagnosis of IAC.The nomogram model we developed has high diagnostic efficiency and application value in early identification of IAC,and it can provide a theoretical refer

关 键 词：肺浸润性腺癌 岩藻糖基转移酶Ⅶ 生物标志物 预测模型 列线图 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]