出 处:《中华胰腺病杂志》2025年第2期112-118,共7页Chinese Journal of Pancreatology
摘 要:目的构建并验证一种基于血脂参数的预测模型用于预测胰腺癌术后辅助化疗患者无复发生存期(RFS)。方法回顾性收集2019年1月至2022年12月间青岛大学附属医院155例行胰腺癌根治术并行术后辅助化疗患者的临床资料,按7∶3比例随机将患者分为训练集(108例)和验证集(47例)。采用X-tile软件计算血脂参数的截断值。采用单因素和多因素COX回归分析与RFS相关的危险因素,建立预测RFS的模型并可视化为列线图。通过受试者工作曲线(ROC)计算曲线下面积(AUC)评价模型的预测效能,通过校准曲线评估模型的准确性和稳定性,通过决策曲线(DCA)评估其临床应用价值。基于列线图模型计算患者个体化复发风险评分,采用X-tile软件确定复发风险评分最佳临界值,并将患者分为复发低危组和高危组,分析组间差异并绘制生存曲线。结果血脂参数中,高载脂蛋白A1组胰腺癌术后辅助化疗患者RFS显著长于低载脂蛋白A1组患者(10.17个月比8.92个月,HR=0.397,95%CI 0.237~0.664),而高总胆固醇组(8.33个月比16.27个月,HR=3.382,95%CI 1.901~5.824)、高低密度脂蛋白组(8.53个月比11.43个月,HR=1.617,95%CI 1.013~2.582)、高脂蛋白a组(8.53个月比14.43个月,HR=2.640,95%CI 1.514~4.604)胰腺癌术后辅助化疗患者RFS显著短于低组患者,差异均有统计学意义(P值均<0.05)。单因素COX回归分析显示,T分期、N分期、高总胆固醇水平、高低密度脂蛋白水平、低载脂蛋白A1水平、高载脂蛋白B水平、高脂蛋白a水平是影响RFS的危险因素;多因素COX回归分析显示,肿瘤位于胰腺体尾部(HR=0.63,95%CI 0.36~0.86,P=0.042)、高T分期(HR=4.85,95%CI 1.47~16.04,P=0.010)、高N分期(HR=2.94,95%CI 1.21~7.15,P=0.018)、高总胆固醇水平(HR=3.61,95%CI 1.46~8.91,P=0.005)、高高密度脂蛋白水平(HR=0.48,95%CI 0.26~0.87,P=0.015)、高脂蛋白a水平(HR=3.17,95%CI 1.61~6.24,P<0.001)是影响RFS的独立危险因素。以上6项危险因素�ObjectiveTo establish and validate a lipid parameter-based prognostic model for predicting recurrence free survival(RFS)in pancreatic cancer patients receiving postoperative adjuvant chemotherapy.MethodsA retrospective analysis was conducted on the clinical and pathological data of 155 patients who underwent pancreatic cancer resection followed by adjuvant chemotherapy at Affiliated Hospital of Qingdao University between January 2019 and December 2022.The patients were randomly divided into a training set(n=108)and a validation set(n=47)in a 7∶3 ratio.X-tile software was used to determine cutoff values for lipid parameters.Univariate and multivariate Cox regression analyses were performed to construct a model predicting RFS,which was then visualized using a nomogram.The model's predictive performance,accuracy and stability,and clinical application value were evaluated using the area under the receiver operating characteristic curve(AUC),calibration curves,and decision curve analysis(DCA),respectively.Individual risk scores for recurrence were calculated based on the nomogram model,and X-tile software was employed to identify optimal cutoff values for risk stratification,which was used to divide patients into low-risk and high-risk groups.Survival differences between two groups were analyzed using survival curves.ResultsAmong lipid parameters,patients with higher apolipoprotein A1 level had obviously longer RFS than those with low apolipoprotein A1 level(10.17 months vs 8.92 months,HR=0.397,95%CI 0.237~0.664);patients with high total cholesterol level had obviously shorter RFS than those with low total cholesterol level(8.33 months vs 16.27months,HR=3.382,95%CI 1.901~5.824);patients with high low-density lipoprotein level had obviously shorter RFS than those with low low-density lipoprotein level(8.53 months vs 11.43 months,HR=1.617,95%CI 1.013~2.582);patients with high lipoprotein(a)had shorter RFS than those with low lipoprotein(a)(8.53 months vs 14.43 months,HR=2.640,95%CI 1.514-4.604);and all the differences
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