基于列线图的女性乳腺癌患者再发第二原发性甲状腺癌风险预测模型的构建和验证  

Construction and validation of nomogram risk prediction model for recurrent second primary thyroid cancer in female patients with breast cancer

作　　者：杨倩倩 夏源 张云飞 杨桂云 郭文佳[2] 张秀华[3] YANG Qianqian;XIA Yuan;ZHANG Yunfei;YANG Guiyun;GUO Wenjia;ZHANG Xiuhua(Nursing School,Xinjiang Medical University,Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Departments of Cancer Research Institute,Affiliated Cancer Hospital of Xinjiang Medical University,Xinjiang Uygur Autonomous Region,Urumqi 830000,China;the Office,Affiliated Cancer Hospital of Xinjiang Medical University,Xinjiang Uygur Autonomous Region,Urumqi 830000,China)

机构地区：[1]新疆医科大学护理学院,新疆乌鲁木齐830000 [2]新疆医科大学附属肿瘤医院肿瘤防治研究所,新疆乌鲁木齐830000 [3]新疆医科大学附属肿瘤医院办公室,新疆乌鲁木齐830000

出　　处：《中国医药导报》2024年第24期117-124,共8页China Medical Herald

基　　金：新疆维吾尔自治区自然科学基金资助项目(2021D01C385);新疆维吾尔自治区重点研发计划项目(2022B03019-4)。

摘　　要：目的分析女性乳腺癌患者再发第二原发性甲状腺癌(SPTC)的影响因素,构建列线图风险预测模型并验证其有效性。方法回顾性分析2015年1月至2020年1月在新疆医科大学附属肿瘤医院确诊的456例乳腺癌女性患者的临床资料。按照7∶3比例将患者分为训练集(320例)和验证集(136例);训练集根据患者有无发生SPTC将其分为再发SPTC组(160例)和未再发SPTC组(160例)。分析女性乳腺癌患者再发SPTC的影响因素,构建列线图预测模型;验证集用于外部验证;模型评估采用受试者操作特征(ROC)曲线、校准曲线和决策曲线分析。结果再发SPTC组和未再发SPTC组体重指数(BMI)、焦虑或抑郁、甲状腺基础疾病、乳腺癌最大肿瘤原发部位、分子分型、雌激素受体状态、孕激素受体(PR)状态、Ki-67计数和淋巴结转移比较,差异有统计学意义(P<0.05)。BMI(OR=2.085)、焦虑或抑郁(OR=2.176)、甲状腺基础疾病(OR=6.525)、PR状态(OR=3.387)是女性乳腺癌患者再发SPTC的危险因素(P<0.05);Ki-67计数(OR=0.987)和淋巴结转移(OR=0.376)为保护因素(P<0.05)。ROC曲线结果显示,训练集和验证集的曲线下面积分别为0.755和0.824;训练集和验证集的校准曲线总体趋势接近理想曲线;在0.22~0.88阈值范围内,模型表现为正的净效益。结论根据影响因素构建的女性乳腺癌患者再发SPTC风险列线图预测模型具有较好的临床预测效能,可为开展早期临床评估及实施个性化护理干预提供理论依据。Objective To analyze the influencing factors of second primary thyroid cancer(SPTC)in female patients with breast cancer,construct a nomogram risk prediction model and verify its validity.Methods The clinical data of 456 female patients diagnosed with breast cancer in Affiliated Cancer Hospital of Xinjiang Medical University from January 2015 to January 2020 were retrospectively analyzed,and they were divided into the training set(320 cases)and the validation set(136 cases)according to the ratio of 7∶3.The training set was divided into the recurrent SPTC group(160 cases)and the non-recurrent SPTC group(160 cases)according to whether SPTC occurred.The influencing factors of SPTC recurrence in female patients with breast cancer were analyzed,and a nomogram prediction model was constructed;validation sets were used for external validation;and the model was evaluated using receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis.Results There were significant differences in body mass index(BMI),anxiety or depression,thyroid basic disease,the largest primary site of breast cancer,molecular typing,estrogen receptor status,progesterone receptor(PR)status,Ki-67 count,and lymph node metastasis between the recurrent SPTC group and the non-recurrent SPTC group(P<0.05).BMI(OR=2.085),anxiety or depression(OR=2.176),thyroid basic disease(OR=6.525),and PR status(OR=3.387)were risk factors for recurrent SPTC in female patients with breast cancer(P<0.05),Ki-67 count(OR=0.987)and lymph node metastasis(OR=0.376)were protective factors(P<0.05).ROC curve results showed that area under the curve of the training set and the verification set were 0.755 and 0.824,respectively;the general trend of calibration curve of the training set and the verification set was close to ideal curve;and the model exhibited a positive net benefit within the threshold range of 0.22-0.88.Conclusion The nomogram risk prediction model of recurrent SPTC in female patients with breast cancer based on the influencing factors ha

关 键 词：乳腺癌 甲状腺癌 列线图预测模型 风险因素 女性 护理干预 

分 类 号：R737.9[医药卫生—肿瘤]