基于中医证素构建晚期胃癌预后预测模型  

Constructing a prognostic prediction model for advanced gastric cancer based on traditional Chinese medicine syn-drome element

作　　者：刘佳鑫 王若璇 周姣云 李跃军 LIU Jiaxin;WANG Ruoxuan;ZHOU Jiaoyun(Oncology department of hunan university of traditional Chinese medicine affiliated provincial hospital of traditional Chinese medicine,Zhuzhou 412000,China)

机构地区：[1]湖南中医药大学附属省直中医医院肿瘤科,湖南株洲412000

出　　处：《四川中医》2025年第4期91-98,共8页Journal of Sichuan of Traditional Chinese Medicine

基　　金：湖南省卫健委科研课题(编号:D202303108992);湖南省卫健委科研课题(编号:D202303107806)。

摘　　要：目的:研究影响初诊晚期胃癌患者的预后因素,构建并评价晚期胃癌患者预后风险预测模型。方法:本研究系统性回顾收集了在2015年1月1日~2022年12月31日时间段内,来自以下五家医疗机构的晚期胃癌初诊患者的临床数据与中医证候信息:湖南中医药大学第一附属医院、湖南中医药大学附属中西医结合医院、湖南中医药高等专科学校附属第一医院、邵阳市中医医院以及湖南中医药大学附属醴陵医院。共计纳入492例患者的相关资料,涵盖其临床症状、中医证候及其构成要素等内容。采用R软件对数据进行处理,并按7∶3随机分为训练集和验证集;采用Cox比例风险模型,包括单因素与多因素分析方法,对预后预测因素进行筛选并构建预后模型。通过校准度评价、区分度评价和有效性评价以证实列线图模型的预测能力。结果:气虚证、血瘀证、血虚证、内燥证、痰证、脓毒症、肿瘤负荷≥1个、T分期、N分期、分化程度、PS评分、是否存在骨转移是预后生存的相关因素;根据上述预测因子建立预后预测模型,结果显示其一致性指数为训练集0.90(95%CI:0.8778~0.9497);验证集0.88(95%CI:0.8263~0.9516);在训练集中,1、2、3年受试者工作特征曲线(ROC曲线)下的面积分别为0.85、0.90及0.93,而在验证集中,该面积则分别为0.77、0.85和0.91;校正曲线显示模型拟合度较好。结论:基于中医证素的晚期胃癌列线图模型能较准确地预测晚期胃癌患者预后风险,可为临床预测晚期胃癌风险提供参考依据。Objective:To identify prognostic factors and develop a predictive model for advanced gastric cancer(AGC)pa-tients,incorporating traditional Chinese medicine(TCM)syndromes.Methods:A retrospective analysis was performed on 492AGC patients from five hospitals affiliated with Hunan University of Traditional Chinese Medicine between January 2015and December 2022.Data were processed using R software,with a 70%~30%split for training and validation sets.Univariate and multivariate Cox regression analyses were conducted to identify significant prognostic factors,and a predictive model was devel-oped.Model performance was evaluated using calibration,discrimination,and effectiveness tests.Results:Significant prognostic factors included Qi deficiency,blood stasis,blood deficiency,internal dryness,phlegm syndrome,sepsis,tumor burden≥1,T/N stage,differentiation grade,PS score,and bone metastasis.The model demonstrated high consistency(C-index:0.90in the training set,0.88in the validation set)and excellent ROC curve performance(0.85~0.93for the training set and 0.77~0.91for the validation set).Calibration confirmed the models predictive accuracy.Conclusion:The TCM-based prognostic model effec-tively predicts the risk of AGC progression,offering a valuable tool for clinical risk assessment and treatment planning.

关 键 词：中医证素 晚期胃癌 预后模型 

分 类 号：R256.3[医药卫生—中医内科学]