不可手术治疗的局部晚期直肠癌患者根治性放化疗后血行转移的影响因素分析  

Analysis of Influencing Factors on Hematogenous Metastasis After Radical Radiotherapy and Chemotherapy in Patients with Unsurgical Locally Advanced Rectal Cancer

作　　者：谢媛媛[1] 许禹[1] 邓亚男 XIE Yuanyuan;XU Yu;DENG Yanan(Nanyang Central Hospital,Nanyang,473000)

机构地区：[1]河南省南阳市中心医院,473000

出　　处：《实用癌症杂志》2025年第3期467-471,488,共6页The Practical Journal of Cancer

摘　　要：目的 分析不可手术治疗的局部晚期直肠癌患者根治性放化疗后血行转移的影响因素。方法 回顾性分析接受根治性放化疗的112例不可手术治疗的局部晚期直肠癌患者的病历资料,根据放化疗后1年内血行转移情况将患者分为转移组(n=34)与未转移组(n=78)。采用单因素、多因素Logistic回归分析血行转移的影响因素,并构建列线图风险预测模型,绘制受试者工作特征(ROC)曲线验证其预测效能。结果 转移组和未转移组在分化程度、白蛋白、血小板、癌胚抗原(CEA)、转化生长因子-β1(TGF-β1)水平方面比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析显示,低分化、白蛋白水平低、血小板水平高、CEA水平高、TGF-β1水平高是不可手术治疗的局部晚期直肠癌患者根治性放化疗后血行转移的危险因素(OR>1,P<0.05)。构建列线图风险预测模型,结果显示该列线图模型的校准曲线和Y-X直线相近,模型准确度良好,验证模型显示C-index值为0.865,具有良好区分度;绘制ROC曲线对风险模型预测效能进行验证,结果显示,列线图风险模型预测不可手术治疗的局部晚期直肠癌患者根治性放化疗后血行转移的AUC为0.865。结论 不可手术治疗的局部晚期直肠癌患者根治性放化疗后存在血行转移风险,低分化、白蛋白水平低、血小板水平高、CEA水平高、TGF-β1水平高均是其危险因素,基于上述危险因素构建的列线图风险预测模型可预测患者血行转移风险。Objective To analyze the influencing factors of hematogenous metastasis after radical radiotherapy and chemotherapy in patients with unsurgical locally advanced rectal cancer.Methods A retrospective analysis was conducted on the medical records of 112 patients with unsurgical locally advanced rectal cancer patients after radical radiotherapy and chemotherapy.Based on their blood metastasis status within one year after radiotherapy and chemotherapy,the patients were divided into a metastatic group(n=34)and a non metastatic group(n=78).Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of hematogenous metastasis.A column chart risk prediction model was constructed,and the receiver operating characteristic(ROC)curve was drawn to verify its predictive efficacy.Results There was a statistical significant difference between the metastatic group and the non metastatic group in terms of differentiation degree,albumin,platelets,carcinoid antigen(CEA),and transforming growth factor-β1(TGF-β1)levels(P<0.05).Multiple Logistic regression analysis showed that low differentiation,low albumin levels,high platelet levels,high CEA levels,and high TGF-β1 levels were risk factors for hematogenous metastasis in unsurgical locally advanced rectal cancer patients after radical radiotherapy and chemotherapy(OR>1,P<0.05).A column chart risk prediction model was constructed,and the results showed that the calibration curve of the column chart model was similar to the Y-X line,with good accuracy.The validation model showed a C-index value of 0.865,with good discrimination.The ROC curve was drawn to validate the predictive performance of the risk model.The results showed that the AUC of the column chart risk model for predicting hematogenous metastasis in unsurgical locally advanced rectal cancer patients after radical radiotherapy and chemotherapy was 0.865.Conclusion Patients with unsurgical locally advanced rectal cancer after radical radiotherapy and chemotherapy have a risk of hemat

关 键 词：直肠癌 局部晚期 不可手术 根治性放化疗 血行转移 影响因素 列线图模型 风险预测 

分 类 号：R735.37[医药卫生—肿瘤]