妇科恶性肿瘤术后淋巴漏形成的相关因素及临床预测模型构建  

Analysis of Related Factors and Construction of Clinical Prediction Model for Postoperative Lymphorrhagia in Patients with Gynecological Malignant Tumors

作　　者：马贵霞 马鸿云[1] 田舒桐 马萱 樊杨[1] MA Guixia;MA Hongyun;TIAN Shutong;MA Xuan;FAN Yang(People's Hospital of Ningxia Hui Autonomos Region,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院,宁夏银川750002

出　　处：《肿瘤学杂志》2024年第12期1043-1048,共6页Journal of Chinese Oncology

基　　金：宁夏回族自治区卫生健康委研究课题(2023-NWKYP-003);宁夏自然科学基金资助项目(2023AAC03487);宁夏回族自治区卫生健康系统科研课题资助项目(2023-NWKYT-006)。

摘　　要：[目的]探讨妇科恶性肿瘤术后淋巴漏发生的相关因素并构建临床预测模型。[方法]回顾性分析行淋巴结切除术的507例妇科恶性肿瘤患者手术资料,根据术后是否发生淋巴漏分为淋巴漏组(59例)和非淋巴漏组(448例),采用秩和检验和χ^(2)检验进行单因素分析,用R语言构建多因素Logistic临床预测模型(数据中80%为训练集,20%为验证集)及列线图进行临床预测。[结果]单因素分析结果显示术前/术后白蛋白、术后前白蛋白、疾病种类、肿瘤分期、淋巴结数目、术中出血量、术后输注白蛋白、手术方式与术后淋巴漏发生有关(P<0.05)。二元Logistic回归模型最终纳入淋巴结数目、术中出血量、术前/术后白蛋白水平、是否患高血压5个变量。训练集构建的模型曲线下面积为(area under the curve,AUC)为0.808[95%置信区间(confidence interval,CI:0.741~0.875)],灵敏度81.4%,特异度65.3%,准确率67.0%;验证集AUC为0.684(95%CI:0.552~0.816),灵敏度68.8%,特异度61.0%,准确率62.2%。[结论]妇科恶性肿瘤术后淋巴漏发生相关因素构建的模型对术后淋巴漏发生具有一定预测作用,可为早期干预提供依据。[Objective]To explore the related factors of postoperative lymphorrhagia of gynecological malignant tumors and construct a clinical prediction model.[Methods]The clinical data of 507 patients who underwent lymphadenectomy were retrospectively analyzed.Based on whether lymphorrhagia occurred postoperatively,the patients were divided into lymphorrhagia group(59 cases)and non-lymphorrhagia group(448 cases).Univariate analysis was performed using the rank sum test and chi-square test,and a multivariate logistic clinical prediction model(80% of the data was the training set and 20% was the validation set)and a nomogram were constructed using the R language for clinical prediction.[Results]The univariate analysis results showed that preoperative/postoperative serum albumin level,postoperative prealbumin level,types of diseases,tumor stage,number of lymph nodes,intraoperative blood loss,postoperative human serum albumin infusion,and surgical method were related to the occurrence of postoperative lymphorrhagia(P<0.05).The binary Logistic regression model ultimately incorporated 5 variables:the number of lymph nodes,intraoperative blood loss,preoperative serum albumin level,postoperative serum albumin level,and hypertension.The area under the curve(AUC)of the model constructed in the training set was 0.808(95%CI:0.741~0.875),with sensitivity 81.4%,specificity 65.3% and accuracy index 67.0% while the AUC in the validation set was 0.684(95%CI:0.552~0.816),with sensitivity 68.8%,specificity 61.0% and accuracy index 62.2%.[Conclusion]The model constructed based on the factors related to the occurrence of lymphorrhagia after gynecological malignant tumor surgery has a predictive value for the postoperative lymphorrhagia,thus providing references for early intervention strategies.

关 键 词：妇科恶性肿瘤 淋巴漏 淋巴结清扫术 临床预测模型 

分 类 号：R737.3[医药卫生—肿瘤]