肝癌患者放化疗后营养不良风险预测列线图模型构建及验证研究  

Construction and validation of nomogram model for risk prediction of malnutrition in patients with liver cancer after radiotherapy and chemotherapy

作　　者：张莎 王九萍 杨进 Zhang Sha;Wang Jiuping;Yang Jin(Department of Infection,Xijing Hospital,Xi'an 710032,Shaanxi,China)

机构地区：[1]空军军医大学第一附属医院(西京医院)感染性疾病科,陕西西安710032

出　　处：《肿瘤代谢与营养电子杂志》2024年第5期698-705,共8页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：西安市科技创新计划项目(2022JQ1018)。

摘　　要：目的探讨肝癌患者放化疗后出现营养不良的影响因素,并基于列线图构建风险预测模型。方法选取2019年6月至2020年12月于空军军医大学第一附属医院(西京医院)接受放化疗且随访至2023年12月的肝癌患者155例作为研究对象,按照放化疗后有无出现营养不良分为营养不良组(n=49)和非营养不良组(n=106),对比基线资料,分析放化疗后出现营养不良的危险因素,并构建列线图预测模型。结果营养不良组和非营养不良组在年龄、TNM分期、门静脉癌栓、分化程度、淋巴结转移、吞咽功能障碍、消化道症状条目、白蛋白、血红蛋白等基线资料比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,门静脉癌栓、低分化、淋巴结转移、吞咽功能障碍、消化道症状条目≥2个、白蛋白<40 g/L、血红蛋白<110 g/L是影响肝癌患者放化疗后出现营养不良的危险因素(P<0.05)。受试者操作特征(ROC)曲线分析显示,列线图预测模型预测肝癌患者放化疗后出现营养不良的ROC曲线的曲线下面积(AUC)为0.936,敏感度为0.880,特异度为0.984。结论门静脉癌栓、低分化、淋巴结转移、吞咽功能障碍、消化道症状≥2个、白蛋白<40 g/L、血红蛋白<110 g/L会对肝癌患者放化疗后出现营养不良产生影响,依据这些危险因素构建列线图模型对预测营养不良具有一定价值,进而制订防治措施。Objective To investigate the influencing factors of malnutrition in patients with liver cancer after radiotherapy and chemotherapy,and to build a risk prediction model based on the column graph.Method A total of 155 patients with liver cancer who received radiotherapy and chemotherapy in the First Affiliated Hospital of Air Force Military Medical University(Xijing Hospital)from June 2019 to December 2020 and were followed up until December 2023 were selected as the study objects.According to whether there was malnutrition after radiotherapy and chemotherapy,they were divided into the malnourished group(n=49)and the non-malnourished group(n=106).Compared with baseline data,the risk factors of malnutrition after chemoradiotherapy were analyzed,and the prediction model was constructed with a nomogram.Result There were significant differences in age,TNM stage,portal vein cancer thrombus,differentiation degree,lymph node metastasis,swallowing dysfunction,gastrointestinal symptoms,albumin,hemoglobin and other baseline data between the malnutrition group and the non-malnutrition group(P<0.05).Logistic regression analysis showed that portal vein cancer thrombus,low differentiation,lymph node metastasis,swallowing dysfunction,gastrointestinal symptoms≥2 items,albumin<40 g/L,hemoglobin<110 g/L were the risk factors for malnutrition in patients with liver cancer after radiotherapy and chemotherapy(P<0.05).ROC curve analysis showed that the ROC curve of the line chart prediction model for predicting nutritional malnutrition in liver cancer patients after chemoradiotherapy had an area under the curve(AUC)is 0.936,the sensitivity is 0.880,and the specificity is 0.984.Conclusion Portal vein cancer thrombolus,low differentiation,lymph node metastasis,swallowing dysfunction,digestive tract symptom items≥2,albumin<40 g/L,hemoglobin<110 g/L may have an impact on malnutrition after radiotherapy and chemotherapy in patients with liver cancer.The construction of a nomogram model based on these risk factors is of certain value in p

关 键 词：肝癌 动脉栓塞化疗 三维适形放射治疗 营养不良 列线图模型 营养干预 康复护理 预后 

分 类 号：R735.7[医药卫生—肿瘤]