术前炎症免疫营养指标预测子宫颈癌淋巴结转移列线图模型构建及验证  

Construction and Validation of a Nomogram for Predicting Lymph Node Metastasis in Cervical Cancer Using Preoperative Inflammatory and Immune Nutritional Indicators

作　　者：许星月 郭依琳 王璐[1] 李梦琦 李瑞[1] 卢富华 赵虎[1] XU Xingyue;GUO Yilin;WANG Lu(Department of Obstetrics and Gynecology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 450014,China)

机构地区：[1]郑州大学第二附属医院妇产科,河南郑州450014 [2]新乡市中心医院妇产科,河南新乡453099

出　　处：《实用妇产科杂志》2024年第8期645-650,共6页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:基于术前炎症免疫营养指标预测术前诊断为早期子宫颈癌患者淋巴结转移并构建列线图预测模型,为子宫颈癌淋巴结转移的术前诊断提供依据和工具。方法:回顾性分析2018年1月至2023年7月在郑州大学第二附属医院妇产科行手术治疗的307例术前诊断为早期子宫颈癌患者的临床资料,用R软件随机化分组包按照3∶1的比例随机分为训练集(n=231)和验证集(n=76)。采用单因素和多因素Logistic回归分析术前诊断为早期子宫颈癌患者淋巴结转移的影响因素,R软件建立列线图预测模型并绘制受试者工作特征(ROC)曲线和校准曲线进行验证。结果:①单因素Logistic回归分析结果显示脉管浸润阳性、血小板与淋巴细胞比值(PLR)≥151.70、中性粒细胞与白细胞比值(NWR)≥0.65、血小板与白蛋白比值(PAR)≥4.94、术前系统性免疫炎症指数(SII)≥604.03、全身炎症反应指数(SIRI)≥1.05与淋巴结转移相关(P<0.05)。②多因素Logistic回归分析发现脉管浸润阳性、NWR≥0.65、PAR≥4.94是术前诊断为早期子宫颈癌患者淋巴结转移的独立危险因素(OR>1,P<0.05)。③构建术前诊断为早期子宫颈癌患者淋巴结转移列线图,ROC曲线显示训练集曲线下面积(AUC)为0.821,验证集AUC为0.858。校准曲线显示训练集平均绝对误差为0.024,验证集平均绝对误差为0.059。结论:应用术前NWR、PAR炎症免疫营养指标所构建的子宫颈癌淋巴结转移预测模型,有助于妇科肿瘤医生术前预测子宫颈癌患者的淋巴结转移情况。Objective:To predict lymph node metastasis in patients preoperatively diagnosed with early-stage cervical cancer based on preoperative inflammatory and immune nutritional indicators,and to construct a nomo-gram prediction model,providing a basis and tool for preoperative diagnosis of lymph node metastasis in cervical cancer.Methods:A retrospective analysis was conducted on the clinical data of 307 patients preoperatively diag-nosed with early-stage cervical cancer who underwent surgical treatment at the Obstetrics and Gynecology De-partment of the Second Affiliated Hospital of Zhengzhou University from January 2018 to July 2023.R software was used to randomize the groups into a training set(n=231)and a validation set(n=76)in a 3∶1 ratio.Uni-variate and multivariate logistic regression analyses were employed to identify factors influencing lymph node me-tastasis in patients preoperatively diagnosed with early-stage cervical cancer.R software was used to establish a nomogram prediction model and draw receiver operating characteristic(ROC)curves and calibration curves for validation.Results:①The results of univariate logistic regression analysis showed that positive lymphovascular invasion,platelet-to-lymphocyte ratio(PLR)≥151.70,neutrophil-to-white blood cell ratio(NWR)≥0.65,plate-let-to-albumin ratio(PAR)≥4.94,preoperative systemic immune-inflammation index(SII)≥604.03,and sys-temic inflammatory response index(SIRI)≥1.05 were associated with lymph node metastasis(P<0.05).②Multivariate logistic regression analysis found that positive lymphovascular invasion,NWR≥0.65,and PAR≥4.94 were independent risk factors for lymph node metastasis in patients preoperatively diagnosed with early-stage cervical cancer(OR>1,P<0.05).③A nomogram was constructed to predict lymph node metastasis in patients preoperatively diagnosed with early-stage cervical cancer.The ROC curve shows an area under the train-ing set curve(AUC)of 0.821 and a validation set AUC of 0.858.The calibration curve shows an average abso-lut

关 键 词：子宫颈癌 淋巴结转移 列线图 炎症免疫营养 

分 类 号：R737.33[医药卫生—肿瘤]