肝内胆管细胞癌手术患者预后预测模型的构建  

Construction of prognosis prediction model for patients undergoing surgery for intrahepatic cholangiocarcinoma

作　　者：孙玉书 卫星 代风雪 牟永平 杨阳 SUN Yushu;WEI Xing;DAI Fengxue;MU Yongping;YANG yang(Department of Medical Oncology,Inner Mongolia Hospital,Peking University Cancer Hospital(Cancer Hospital Affiliated to Inner Mongolia Medical University),Hohhot 010021,China)

机构地区：[1]北京大学肿瘤医院内蒙古医院(内蒙古医科大学附属肿瘤医院)消化肿瘤内科,呼和浩特010021 [2]北京大学肿瘤医院内蒙古医院(内蒙古医科大学附属肿瘤医院)肝胆外科,010021 [3]北京大学肿瘤医院内蒙古医院(内蒙古医科大学附属肿瘤医院)检验科,010021

出　　处：《临床肿瘤学杂志》2025年第2期143-148,共6页Chinese Clinical Oncology

摘　　要：目的探讨影响肝内胆管细胞癌手术患者预后的因素并构建预测模型。方法回顾性收集2015年1月至2021年6月于北京大学肿瘤医院内蒙古医院行手术切除的肝内胆管细胞癌患者158例,分析患者的临床病理资料,并随访总生存时间(OS)。比较不同临床病理特征亚组患者的术后中位OS。采用Cox风险比例回归模型分析影响肝内胆管细胞癌手术患者OS的因素。根据多因素Cox回归分析筛选出来的变量构建列线图预测模型并验证。结果随访截止至2023年9月,158例患者的中位OS为19.0个月,术后1年和3年生存率分别为64.7%和32.3%。有无肝内胆管结石、肿瘤病灶数目、肝脏切除范围、肿瘤分化程度、肿瘤细胞类型、肿瘤最大径、有无合并脉管侵犯、TNM分期、有无淋巴结转移、有无卫星灶、切缘状态及CA19-9水平亚组患者中位OS的差异均有统计学意义(P<0.05)。多因素Cox风险比例回归模型结果显示,肝内胆管结石、病灶数目、肝脏切除范围、肿瘤分化程度、肿瘤细胞类型及CA19-9水平均是影响肝内胆管细胞癌手术患者OS的独立因素(P<0.05)。依据多因素分析筛选出的变量构建列线图风险模型,一致性指数(C-index)为0.713。利用Bootstrap自抽样法进行内部验证,重复自抽样500次,获得校准曲线,校准曲线的平均绝对误差为0.016。结论肝内胆管细胞癌手术患者的预后受有无肝内胆管结石、肿瘤病灶数目、肝脏切除范围、肿瘤分化程度、肿瘤细胞类型及CA19-9水平等多种因素影响;构建的列线图模型可以获得较为良好的预测效果。Objective To explore the factors affecting the prognosis of patients undergoing surgery for intrahepatic cholangiocarcinoma and construct a predictive model.Methods A total of 158 patients with intrahepatic cholangiocarcinoma underwent surgical resection in Inner Mongolia Hospital,Peking University Cancer Hospital from January 2015 to June 2021 were retrospectively collected.Clinicopathological characteristics of the patients were analyzed,and the overall survival time(OS)was followed up.The median OS of patients in different clinicopathological subgroups was compared.Cox proportional regression model was used to analyze the factors affecting OS in patients undergoing surgery for intrahepatic cholangiocarcinoma.The nomogram prediction model was constructed and verified according to the variables screened by multi-factor analysis.Results Follow-up until September 2023,the median OS of 158 patients was 19.0 months,and the 1-year and 3-year overall survival rates after surgery were 64.7%and 32.3%,respectively.There were statistically significant differences in median OS among subgroups with or without intrahepatic bile duct calculus,number of tumor lesions,scope of liver resection,degree of tumor differentiation,tumor cell type,maximum tumor diameter,presence or absence of vascular invasion,TNM stage,presence or absence of lymph node metastasis,presence or absence of satellite lesion,incisal border status,and CA19-9 level(P<0.05).Multivariate Cox proportional regression model showed that intrahepatic bile duct calculi,number of lesions,scope of liver resection,tumor differentiation degree,tumor cell type and CA19-9 level were all independent factors influencing OS in patients undergoing intrahepatic cholangiocarcinoma surgery(P<0.05).The nomogram risk model was constructed based on the selected variables from the multi-factor analysis,and the consistency index(C-index)was 0.713.Bootstrap self-sampling method was used for internal verification,and the calibration curve was obtained by repeated self-sampling 500 times

关 键 词：肝内胆管细胞癌 手术 总生存时间 预测模型 

分 类 号：R735.7[医药卫生—肿瘤]