胰腺癌患者首次化疗后中重度骨髓抑制的相关危险因素分析及预测模型构建  

Analysis of risk factors related to moderate to severe myelosuppression in patients with pancreatic cancer after first chemotherapy and construction of prediction model

作　　者：罗文斌 韩玮[1] Luo Wenbin;Han Wei(Department of Pancreatic Surgery,Digestive Vascular Surgery Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院胰腺外科,消化血管外科中心,乌鲁木齐830000

出　　处：《中华普通外科学文献（电子版）》2024年第5期357-362,共6页Chinese Archives of General Surgery(Electronic Edition)

基　　金：国家自然科学基金项目(82360585)。

摘　　要：目的探讨胰腺导管腺癌(PDAC)患者首次化疗后中重度骨髓抑制的相关危险因素,并构建预测模型。方法采用整群抽样法,选取2018年1月至2022年12月新疆医科大学第一附属医院病理明确诊断PDAC并接受化疗的123例患者临床资料,将未发生或发生轻度骨髓抑制的68例设为对照组,发生中重度骨髓抑制的55例设为观察组。Logistic单因素和多因素回归分析筛选出首次化疗后中重度骨髓抑制的危险因素并构建预测模型。采用Hosmer-Lemeshow检验及受试者工作特征(ROC)曲线判断回归模型的预测效能。结果多因素回归分析显示,中性粒细胞计数<3.40×109/L(OR=2.890,95%CI:1.332~6.269,P=0.007)、血红蛋白<118 g/L(OR=2.374,95%CI:1.092~5.163,P=0.029)、控制营养状况评分≥2分(OR=2.635,95%CI:1.206~5.756,P=0.015)是PDAC患者化疗后发生中重度骨髓抑制的独立危险因素。构建的回归预测模型敏感度为74.5%,特异度为64.7%,约登指数为0.393,ROC曲线下面积为0.716(95%CI:0.625~0.807),具有良好的预测价值,Hosmer-Lemeshow检验拟合程度良好(χ2=3.335,P=0.766)。结论PDAC患者化疗前中性粒细胞、血红蛋白和控制营养状况评分是首次化疗后中重度骨髓抑制的重要影响因素,化疗前早期诊断并采取干预措施有望改善患者预后。Objective To investigate the risk factors of moderate to severe myelosuppression in patients with pancreatic ductal adenocarcinoma(PDAC)after the first chemotherapy,and to establish a predictive model.Methods A cluster sampling method was used to select the clinical data of 123 patients with PDAC confirmed by pathological diagnosis and chemotherapy in the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022.68 patients with mild or no myelosuppression were set as the control group,and 55 patients with moderate or severe myelosuppression were set as the observation group.Logistic univariate and multivariate regression analysis screened out the risk factors of moderate and severe myelosuppression after thefirst chemotherapy and constructed the prediction model.Hosmer-Lemeshow test and receiver operating characteristic(ROC)curve were used to determine the predictive efficiency of the regression model.Results By multivariate analysis,absolute neutrophil count<3.40×109/L(OR=2.890,95%CI:1.332-6.269,P=0.007),hemoglobin<118 g/L(OR=2.374,95%CI:1.092-5.163,P=0.029)and CONUT≥2(OR=2.635,95%CI:1.206-5.756,P=0.015)were independent risk factors for moderate to severe myelosuppression after chemotherapy in PDAC patients.The constructed regression prediction model had sensitivity of 74.5%,specificity of 64.7%,Yoden index of 0.393,and area under ROC D0I:10.3877-0793.2024.05.008 curve of 0.716(95%CI:0.625-0.807)had good predictive value,and the Hosmer-Lemeshow test had a goodfitting degree(χ2=3.335,P=0.766).Conclusions The scores of absolute neutrophil count,hemoglobin and nutrient control before chemotherapy in PDAC patients are important factors affecting moderate to severe myelosuppression after thefirst chemotherapy.Early diagnosis and intervention before chemotherapy are expected to improve the prognosis of patients.

关 键 词：胰腺肿瘤 化学疗法 辅助 骨髓抑制 危险因素 模型 统计学 

分 类 号：R735.9[医药卫生—肿瘤]