预测听神经瘤术后面神经功能结局的列线图模型构建与验证  

Construction and validation of a Nomogram model for predicting the outcome of facial nerve function after acoustic neuroma surgery

作　　者：郐国虎 廉明昊 李彦东 章高财 朱国华[1] 麦麦提力·米吉提[1] 更·党木仁加甫 KUAI Guohu;LIAN Minghao;LI Yandong;ZHANG Gaocai;ZHU Guohua;Maimaitili Mijiti;Geng Dangmurenjiafu(Department of Neurosurgery,the First Teaching Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院神经外科,乌鲁木齐830054

出　　处：《中国临床新医学》2025年第3期303-307,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：新疆维吾尔自治区自然科学基金项目(编号:2023D01C98)。

摘　　要：目的构建预测听神经瘤(AN)术后面神经功能(FNF)结局的列线图模型并进行验证。方法收集2020年9月至2023年12月新疆医科大学第一附属医院神经外科收治的124例AN患者的临床资料,均行乙状窦后入路切除肿瘤。采用多因素logistic回归分析筛选影响AN术后FNF结局的因素,将其纳入构建列线图模型并进行内部验证。结果124例AN患者中术后FNF预后良好57例(预后良好组),预后不良67例(预后不良组)。与预后良好组相比,预后不良组年龄、肿瘤直径、肿瘤前部长度、肿瘤后部长度更大,肿瘤与面神经粘连程度为中度和重度以及肿瘤性质为囊性的人数比例更大,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,较大的年龄[OR(95%CI)=1.078(1.025~1.134)]和肿瘤直径[OR(95%CI)=2.231(1.274~3.906)]、肿瘤性质为囊性[OR(95%CI)=7.601(2.212~26.124)]、肿瘤与面神经粘连程度为中度[OR(95%CI)=11.182(3.023~41.364)]和重度[OR(95%CI)=86.653(13.414~559.774)]是AN患者术后FNF预后不良的独立危险因素(P<0.05)。以年龄、肿瘤性质、肿瘤直径、肿瘤与面神经粘连程度4个变量构建列线图模型。受试者工作特征(ROC)曲线分析结果显示,该模型曲线下面积(AUC)为0.920(95%CI:0.869~0.971),预测效能较高。采用Bootstrap重抽样法(1000次)对模型校准度进行验证,校准曲线接近理想曲线,提示该模型具有较好的预测价值。决策分析曲线(DAC)分析结果显示,在5%~65%阈值范围下,曲线位于None线和All线上方,提示该模型具有较好的临床实用性。结论该研究构建的列线图模型能有效预测AN术后FNF结局,具有临床应用价值。Objective To construct and validate a Nomogram model for predicting the outcome of facial nerve function(FNF)after acoustic neuroma(AN)surgery.Methods The clinical data of 124 patients with AN who were admitted to Department of Neurosurgery,the First Teaching Hospital of Xinjiang Medical University from September 2020 to December 2023 were collected.All the patients underwent tumor resection through the retrosigmoid sinus approach.Multivariate logistic regression analysis was used to screen factors affecting the outcome of FNF after AN surgery,and these factors were incorporated to construct a Nomogram model.Internal validation was conducted for the Nomogram model.Results Among the 124 patients with AN,the prognosis of FNF after surgery was good in 57 cases(good prognosis group)and poor in 67 cases(poor prognosis group).Compared with the good prognosis group,the poor prognosis group was older,and had larger tumor diameter,anterior tumor length and posterior tumor length,and higher proportion of patients with moderate to severe tumor adhesion to facial nerve and cystic tumor in nature,with statistically significant differences between the two groups(P<0.05).The results of multivariate logistic regression analysis showed that older age[OR(95%CI)=1.078(1.025-1.134)],larger tumor diameter[OR(95%CI)=2.231(1.274-3.906)],cystic tumor in nature[OR(95%CI)=7.601(2.212-26.124)],moderate tumor adhesion to facial nerve[OR(95%CI)=11.182(3.023-41.364)]and severe tumor adhesion to facial nerve[OR(95%CI)=86.653(13.414-559.774)]were independent risk factors for poor prognosis of FNF in the AN patients after surgery(P<0.05).Age,tumor nature,tumor diameter,and the severity of tumor adhesion to facial nerve were used as 4 variables to construct the Nomogram model.The results of receiver operating characteristic(ROC)curve analysis showed that area under the curve(AUC)of the model was 0.920(95%CI:0.869-0.971),indicating that the model had relatively high predictive efficiency.The calibration degree of the model was validated by Bootstr

关 键 词：听神经瘤 乙状窦后入路 列线图 面神经功能 预测模型 

分 类 号：R739.45[医药卫生—肿瘤]