基于临床多变量构建胃肝样腺癌预后的诺曼图预测模型  

Risk factors and nomogram construction for predicting long-term survival in hepatoid adenocarcinoma of the stomach

作　　者：卢誉元 崔昊 曹博 徐其轩 高兢望 赵瑞阳 任慧广 袁震 杜家俊 孙嘉鸿 崔建新[1] 卫勃[1] Lu Yuyuan;Cui Hao;Cao Bo;Xu Qixuan;Gao Jingwang;Zhao Ruiyang;Ren Huiguang;Yuan Zhen;Du Jiajun;Sun Jiahong;Cui Jianxin;Wei Bo(Department of General Surgery,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;School of Medicine,Nankai University,Tianjin 300071,China)

机构地区：[1]解放军总医院第一医学中心普通外科学部,北京100853 [2]南开大学医学院,天津300071

出　　处：《中华胃肠外科杂志》2025年第2期157-168,共12页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82073192,62133010,82273231);北京市科技计划项目(Z221100007422125)。

摘　　要：目的分析胃肝样腺癌(HAS)预后的危险因素,并构建预测HAS患者总体生存(OS)和无复发生存(RFS)的诺曼图临床预测模型。方法本研究采用观察性研究方法。回顾性收集2006年2月至2023年9月解放军总医院第一医学中心行胃癌根治术并经病理证实为HAS的82例患者资料,其中男64例,女18例,年龄30~80(60.3±9.4)岁。采用Kaplan-Meier法进行生存分析,使用单因素Cox回归分析临床病理变量对HAS预后的影响,将单因素分析中P<0.05的变量纳入多因素Cox回归模型,筛选出HAS预后的影响因素,并基于以上因素分别构建OS和RFS的诺曼图预测模型。通过受试者工作特征(ROC)曲线下面积(AUC)评价模型的区分度,校准曲线和临床决策曲线(DCA)验证模型的效能,并与第8版美国癌症联合委员会(AJCC)指南胃癌pTNM分期系统进行比较。结果82例患者中36例(43.9%)存在脉管浸润,61例(74.4%)存在神经浸润;病理分期Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期分别为11例(13.4%)、26例(31.7%)、44例(53.7%)以及1例(1.2%);60例(73.2%)存在淋巴结转移;中性粒细胞和淋巴细胞数值比(NLR)≥4.33者22例(26.8%),血小板和淋巴细胞数值比(PLR)≥142.2者50例(61.0%),单核细胞和淋巴细胞数值比(MLR)≥0.411者22例(26.8%),甲胎蛋白(AFP)≥2.48μg/L者64例(78.0%),C反应蛋白(CRP)≥7.51 mg/L者12例(14.6%)。全组82例患者中,失访3例(3.6%)。全组中位随访时间52(8~147)个月,中位生存时间为61(2~147)个月,1年和3年OS分别为78.5%和58.5%;1年和3年RFS分别为77.3%和60.3%。多因素分析结果显示,病理分期晚[HR(95%CI):5.218(1.230~22.143)]、术前MLR≥0.411[HR(95%CI):2.610(1.287~5.294)]、AFP≥2.545μg/L[HR(95%CI):2.950(1.013~8.589)]和CRP≥7.506 mg/L[HR(95%CI):2.594(1.145~5.877)]是影响HAS患者OS的独立危险因素(均P<0.05);病理分期晚[HR(95%CI):4.735(1.080~20.760)]、术前PLR≥152.0[HR(95%CI):3.759(1.259~11.226)]以及MLR≥0.411[HR值(95%CI):2.714(1.218~6.048)]是影响HAS患者RFS的独Objective This study aimed to analyze the prognostic risk factors for hepatoid adenocarcinoma of the stomach(HAS)and construct two nomogram-based clinical prediction models to predict overall survival(OS)and recurrence-free survival(RFS)in patients with HAS.Methods Data were retrospectively collected from 82 patients(64 males,18 females;mean age 60.3±9.4 years)who underwent radical gastrectomy and were pathologically diagnosed with gastric hepatoid adenocarcinoma at the First Medical Center of the PLA General Hospital between February 2006 and September 2023.Statistical analyses were conducted using SPSS 25.0 and R 4.3.2.Survival analyses were performed using the Kaplan-Meier method,and univariate analyses were used to identify clinical and pathological factors associated with prognosis.Variables with P<0.05 in the univariate analysis were included in multivariate Cox regression models to identify independent risk factors for OS and RFS.These factors were incorporated into the prediction models to construct nomograms.The discriminatory power of the models was assessed using the area under the curve(AUC)of receiver operating characteristic(ROC)analyses,while calibration curves,decision curve analysis(DCA),and comparisons with the 8th edition of the TNM staging system of the American Joint Committee on Cancer(AJCC)were employed to evaluate model performance.Results Among the 82 patients,36(43.9%)exhibited vascular infiltration,61(74.4%)had nerve infiltration,and lymph node metastasis was observed in 60 cases(73.2%).Pathological stages I,II,III,and IV were distributed as 11(13.4%),26(31.7%),44(53.7%),and 1(1.2%)cases,respectively.Inflammatory markers included neutrophil-to-lymphocyte ratio(NLR)≥4.33 in 22 cases(26.8%),platelet-to-lymphocyte ratio(PLR)≥142.2 in 50 cases(61.0%),monocyte-to-lymphocyte ratio(MLR)≥0.411 in 22 cases(26.8%),α-fetoprotein(AFP)≥2.48µg/L in 64 cases(78.0%),and C-reactive protein(CRP)≥7.506 mg/L in 12 cases(14.6%).Among the 82 patients,3 cases(3.6%)were lost to follow-up.The media

关 键 词：胃肿瘤 肝样腺癌 诺曼图 远期生存 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]