早期结直肠癌内镜黏膜下剥离术后复发危险因素分析及列线图预测模型的构建
Analysis of risk factors for recurrence of early colorectal cancer after endoscopic submucosal dissection and construction of a prediction model based on Nomogram
龚庆豪 1高平发 1朱荣华 1李鹏程 1丁新德1
作者信息
- 1. 上海健康医学院附属崇明医院肛肠外科,上海 202150
- 折叠
摘要
目的 研究早期结直肠癌内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后复发危险因素分析及列线图预测模型的构建.方法 选取2020年1月至2023年1月在我院行早期结直肠癌ESD后患者100例作为研究对象,按照术后是否复发将其分为未复发组(n=75)、复发组(n=25),对其危险因素进行Logistic回归分析,在此基础上建立列线图生存预测模型,利用C指数进行区分度评价及校准曲线进行列线图拟合度检测.结果 肿瘤的位置、大小、浸润深度和T分期对早期结直肠癌患者在接受ESD后的复发风险有显著影响(P均＜0.05).进行多因素Logistic回归分析显示,肿瘤的位置、大小、浸润深度和T分期是复发的独立危险因素(P＜0.05).通过对这些影响因素进行评分,最终总分为175分,此时列线图底端的复发率为37％.列线图预测模型判断复发风险的C指数为0.728(95％CI:0.693～0.869),早期结直肠癌ESD后复发预测模型校准曲线显示,该列线图模型的复发风险的预测发生概率和实际发生概率之间具有较好的一致性,且该列线图模型对预测结果的拟合程度良好(P=0.428);列线图预测模型ROC曲线的AUC为0.781,灵敏度为72.47％,特异度为78.55％.结论 肿瘤位置、肿瘤大小、浸润深度、TNM分期是早期结直肠癌ESD后患者复发的危险因素,模型构建成功且具有良好的区分度和拟合度.
Abstract
Objective To investigate the analysis of risk factors for recurrence of early colorectal cancer after endo-scopic submucosal dissection(ESD)and the construction of a prediction model of Nomogram.Methods From Jan.2020 to Jan.2023,100 patients with early colorectal cancer after ESD were selected as research objects in our hospital,and they were divided into non-recurrence group(n=75)and recurrence group(n=25)according to whether or not they had recurred after surgery.Logistic regression analysis was performed on their risk factors,and a nomographic sur-vival prediction model was established on this basis.The C index was used to evaluate the degree of differentiation and the calibration curve was used to detect the fit degree of the Nomogram.Results The tumor location,tumor size,depth of invasion and T stage all affected recurrence after ESD of early colorectal cancer(P＜0.05).Multivariate Logistic re-gression analysis showed that tumor location,tumor size,depth of invasion and T stage were independent risk factors for recurrence in patients with early colorectal cancer after ESD(P＜0.05).According to the assignment of different influ-encing factors,the total score of tumor size,invasion depth,tumor location and T stage was calculated as 175 points,and the recurrence rate at the bottom of the column chart was 37％.The C-index of recurrence risk was 0.728(95％CI:0.693-0.869),the calibration curve of the recurrence prediction model after ESD of early colorectal cancer showed that there was a good consistency between the predicted probability of recurrence risk and the actual probability of recurrence risk in the column graph model.It showed that the model fit the prediction results well(P=0.428).The results showed that the AUC of the Nomogram prediction model ROC was 0.781,the sensitivity was 72.47％,and the spe-cificity was 78.55％.Conclusion Tumor location,tumor size,depth of invasion and TNM stage are risk factors for re-currence in patients with early colorectal cancer after ESD.The model was successfully constructed,and the constructed model has good differentiation and fit.
关键词
早期结直肠癌/内镜黏膜下剥离术/复发危险因素/预测模型Key words
Early colorectal cancer/Endoscopic submucosal dissection/Recurrence risk factors/Prediction model引用本文复制引用
基金项目
上海市崇明区"可持续发展科技创新行动计划项目"(CKY2020-13)
出版年
2024
NETL
NSTL
万方数据