以营养风险筛查2002评分建立胃结直肠癌患者术后生存期预测模型  

A novel nomogram-based model to predict the postoperative overall survival in patients with gastric and colorectal cancer

作　　者：王思文 徐康菁 高学金 高婷婷[2] 孙广明 肖亚琴 王浩阳 曾程浩 宋得帅 张玉鹏 黄凌莉 廉博 陈建交 郭栋 贾震易 王勇[9] 龚方友[10] 周军德[11] 薛志刚 陈志达[13] 李刚[4] 李孟彬 赵伟 周岩冰[7] 秦环龙[8] 伍晓汀[9] 王昆华[10] 迟强[11] 于健春[12] 唐云[13] 李国立 章黎[2,3] 王新颖 Wang Siwen;Xu Kangjing;Gao Xuejin;Gao Tingting;Sun Guangming;Xiao Yaqin;Wang Haoyang;Zeng Chenghao;Song Deshuai;Zhang Yupeng;Huang Lingli;Lian Bo;Chen Jianjiao;Guo Dong;Jia Zhenyi;Wang Yong;Gong Fangyou;Zhou Junde;Xue Zhigang;Chen Zhida;Li Gang;Li Mengbin;Zhao Wei;Zhou Yanbing;Qin Huanlong;Wu Xiaoting;Wang Kunhua;Chi Qiang;Yu Jianchun;Tang Yun;Li Guoli;Zhang Li;Wang Xinyin(Department of General Surgery,Jinling Hospital,Southern Medical University,Nanjing 210002,China;Department of General Surgery,Jinling Hospital,Nanjing University,Nanjing 210002,China;Department of General Surgery,Jinling Hospital,Nanjing Medical University,Nanjing 210002,China;Department of General Surgery,Cancer Institute of Jiangsu Province,Jiangsu Cancer Hospital,the Afiliated Cancer Hospital of Nanjing Medical University,Nanjing 210002,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China;Department of General Surgery,Northern Jiangsu Province People's Hospital,Yangzhou 225001,China;Department of Gastrointestinal Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266071,China;Department of General Surgery,Shanghai Tenth People's Hospital,School of Medicine,Tongji University,Shanghai 200072,China;Department of Gastrointestinal Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of General Surgery,First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of General Surgery,the 2nd Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of General Surgery,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]南方医科大学第一临床医学院普通外科,南京210002 [2]南京大学附属金陵医院普通外科,南京210002 [3]南京医科大学附属金陵临床医学院普通外科,南京210002 [4]江苏省肿瘤医院普通外科,南京210002 [5]解放军第四军医大学第一附属医院胃肠外科,西安710032 [6]苏北人民医院普通外科,扬州225001 [7]青岛大学医学院附属医院胃肠外科,青岛266071 [8]上海市第十人民医院普通外科,上海200072 [9]四川大学华西医院胃肠外科,成都610041 [10]昆明医科大学第一附属医院普通外科,昆明650032 [11]哈尔滨医科大学附属第二医院普通外科,哈尔滨150001 [12]中国医学科学院北京协和医院普通外科,北京100730 [13]解放军总医院普通外科,北京100853

出　　处：《中华临床营养杂志》2024年第3期138-149,共12页Chinese Journal of Clinical Nutrition

基　　金：国家公益性行业科研专项项目(201502022);江苏省科技计划社会发展——临床前沿技术项目(BE2022822)。

摘　　要：目的研究旨在开发一个新的可视化列线图模型来预测术后总生存率。方法研究为多中心、回顾性、观察性队列研究,纳入2015年8月1日至2018年6月30日在全国11家医疗中心接受根治性手术的胃癌和结直肠癌患者。收集基线临床、病理数据和营养状况评估,包括营养风险筛查2002(nutritional risk screening 2002,NRS 2002)评分和患者主观整体评估评分。采用最小绝对收缩和选择算子回归模型和Cox回归模型进行变量筛选,并进行内部和外部验证。结果训练组和验证组分别有681例和127例患者。中位随访时间为59(58~60)个月,共观察到188例患者死亡。研究最终筛选出两个独立的预测因子(NRS 2002评分和肿瘤TNM病理分期),将其与年龄共同纳入预测模型并绘制列线图。该模型1年、3年和5年总生存期的一致性指数在训练组分别为0.696、0.724和0.738,在验证组分别为0.801、0.812和0.793。结论研究开发并验证了一个基于NRS 2002评分、新的用于预测胃结直肠癌患者术后总生存期的列线图预测模型,该模型在预测胃肠癌患者根治术后长期生存率方面具有良好的区分度、校准度和临床实用性。Objective We aimed to develop a novel visualized model based on nomogram to predict postoperative overall survival.Methods This was a multicenter,retrospective,observational cohort study,including participants with histologically confirmed gastric and colorectal cancer who underwent radical surgery from 11 medical centers in China from August 1,2015 to June 30,2018.Baseline characteristics,histopathological data and nutritional status,as assessed using Nutrition Risk Screening 2002(NRS 2002)score and the scored Patient-Generated Subjective Global Assessment,were collected.The least absolute shrinkage and selection operator regression and Cox regression were used to identify variables to be included in the predictive model.Internal and external validations were performed.Results There were 681 and 127 patients in the training and validation cohorts,respectively.A total of 188 deaths were observed over a median follow-up period of 59(range:58 to 60)months.Two independent predictors of NRS 2002 and Tumor-Node-Metastasis(TNM)stage were identified and incorporated into the prediction nomogram model together with the factor of age.The model's concordance index for 1-,3-and 5-year overall survival was 0.696,0.724,and 0.738 in the training cohort and 0.801,0.812,and 0.793 in the validation cohort,respectively.Conclusions In this study,a new nomogram prediction model based on NRS 2002 score was developed and validated for predicting the overall postoperative survival of patients with gastric colorectal cancer.This model has good differentiation,calibration and clinical practicability in predicting the long-term survival rate of patients with gastrointestinal cancer after radical surgery.

关 键 词：胃结直肠癌 NRS 2002评分 术后生存期 列线图 多中心研究 

分 类 号：R735.3[医药卫生—肿瘤]