术前临床参数对结直肠癌肝转移根治性切除术后早期复发的预测价值  

Predictive value of preoperative clinical parameters for early recurrence after radical resection of colorectal cancer liver metastases

作　　者：马瑞东 李佳玮 罗诗樵[1] MA Ruidong;LI Jiawei;LUO Shiqiao(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院肝胆外科,重庆400016

出　　处：《医学新知》2025年第4期419-429,共11页New Medicine

基　　金：重庆医科大学未来医学青年创新团队项目(W0087)。

摘　　要：目的探究影响结直肠癌肝转移(colorectal cancer liver metastases,CRLM)患者根治性切除术后早期复发的危险因素并建立预测模型。方法回顾性分析2012年1月至2023年6月重庆医科大学附属第一医院接受根治性切除术的CRLM患者的临床资料。使用Logistic回归和Lasso回归分析方法探究影响早期复发的危险因素,并根据危险因素构建列线图预测模型。使用受试者工作特征曲线的曲线下面积(AUC)、校准曲线、临床决策曲线评估模型的区分度、校准度和临床适用性。结果共纳入242例患者,并随机分为训练组(169例)和验证组(73例)。Logistic回归分析和Lasso回归分析结果显示,术前系统免疫炎症指数(SII)≥470.1[OR=2.96,95%CI(1.14,7.67)]、预后营养指数(PNI)<43.5[OR=5.91,95%CI(1.41,24.84)]、白蛋白与球蛋白比值(AGR)<1.3[OR=7.62,95%CI(2.78,20.90)]、癌胚抗原(CEA)≥5.8 ng/mL[OR=2.93,95%CI(1.09,7.86)]、肝转移瘤双叶分布[OR=3.66,95%CI(1.40,9.57)]是影响CRLM患者术后早期复发的独立危险因素。以此为基础构建列线图模型,模型在训练组、验证组的AUC分别为0.884、0.869,提示列线图区分度良好;校准曲线显示该列线图模型具有良好的校准度,临床决策曲线分析显示其临床适用性较强。结论术前SII≥470.1、PNI<43.5、AGR<1.3、CEA≥5.8 ng/mL、肝转移瘤双叶分布是影响CRLM术后早期复发的独立危险因素,以此为依据构建列线图模型可有效预测患者术后的早期复发。Objective To investigate the risk factors influencing early recurrence after radical resection in patients with colorectal cancer liver metastases(CRLM)and to develop a predictive model.Methods A retrospective analysis was conducted on the clinical data of CRLM patients who underwent radical resection from January 2012 to June 2023.Logistic regression and Lasso regression analysis were utilized to explore the risk factors for early recurrence,and a nomogram was constructed based on the risk factors.Assessing model discrimination using area under the curve(AUC)of the receiver operating characteristic curve,plotting calibration curves,and clinical decision curves to assess model calibration and clinical utility.Results The study included 242 patients,who were randomly divided into a training cohort(169 patients)and a validation cohort(73 patients).The Logistic and Lasso regression analyses identified preoperative systemic immune-inflammation index(SII)≥470.1[OR=2.96,95%CI(1.14,7.67)],prognostic nutritional index(PNI)<43.5[OR=5.91,95%CI(1.41,24.84)],albumin-globulin ratio(AGR)<1.3[OR=7.62,95%CI(2.78,20.90)],carcinoembryonic antigen(CEA)≥5.8 ng/mL[OR=2.93,95%CI(1.09,7.86)],and bilobar distribution of liver metastases[OR=3.66,95%CI(1.40,9.57)]as independent risk factors for early recurrence.The nomogram developed from these findings demonstrated good discriminative ability with AUCs of 0.884 in the training cohort and 0.869 in the validation cohort.The calibration curve indicated that the nomogram model exhibited excellent calibration,and the clinical decision curve analysis suggested strong clinical utility.Conclusion Preoperative SII≥470.1,PNI<43.5,AGR<1.3,CEA≥5.8 ng/mL,and bilobar distribution of liver metastases are significant independent risk factors for early recurrence in CRLM patients.The nomogram constructed based on these factors can effectively predict early recurrence in postoperative patients.

关 键 词：结直肠癌肝转移 早期复发 根治性切除 预测模型 列线图 

分 类 号：R735.7[医药卫生—肿瘤]