摘要
目的 研究初诊前列腺癌骨转移的危险因素,并构建前列腺癌患者发生骨转移的列线图模型.方法 回顾性分析2015年1月至2023年2月就诊于河北医科大学第三医院泌尿外科204例初诊前列腺癌患者的临床资料,根据骨扫描结果进行分组,筛选出前列腺癌发生骨转移的独立危险因素,联合各独立危险因素构建列线图预测模型,绘制受试者工作特征曲线(ROC)以及列线图模型的校准曲线评估模型的预测效能,并用23例外部数据进行验证.结果 单因素分析显示,组间差异有统计学意义的为血清总前列腺特异性抗原、前列腺特异性抗原密度(PSAD)、中性粒细胞/淋巴细胞比值、系统免疫炎症指数、D-二聚体(DD)、碱性磷酸酶(ALP)、血清钙水平、Gleason评分和临床肿瘤分期(cTx).多因素Logistic回归分析显示,PSAD、DD、ALP、Gleason评分和cTx为前列腺癌发生骨转移的独立危险因素.以5个独立危险因素构建预测模型时,预测模型的曲线下面积(AUC)为0.973(95％CI:0.955～0.991),各独立危险因素AUC分别为0.853、0.886、0.873、0.813、0.842,明显高于单个独立危险因素,对前列腺癌发生骨转移的预测效果最佳.当对独立危险因素均取阴性值时,共筛选出65例患者,均未发生骨转移,考虑31.9％(65/204)的患者无需行骨显像检查.使用23例外部数据对预测模型进行验证,敏感性和特异性分别为90.9％(10/11)、91.7％(11/12),与模型的敏感性91.5％和特异性93.4％基本相符,发现模型的准确性和稳定性均较好.结论 PSAD、DD、ALP、Gleason评分和cTx是前列腺癌发生骨转移的独立危险因素;本次构建的列线图模型对前列腺癌发生骨转移有较高的预测价值.
Abstract
Objective To study the risk factors in bone metastases in newly diagnosed prostate cancer and to construct a nomogram model of bone metastases in prostate cancer patients.Methods Clinical data of 204 newly diagnosed prostate cancer patients admitted to the Department of Urolo-gy,Third Hospital of Hebei Medical University from January 2015 to February 2023 were retrospec-tively analyzed.Independent risk factors in bone metastases of prostate cancer were screened accord-ing to bone scan results,and a nomogram prediction model was constructed by combining the inde-pendent risk factors.The receiver operating characteristic curve(ROC)and calibration curve of the nomogram model were plotted to evaluate the predictive efficiency of the model,and the predictive model was validated with data of 23 cases.Results Univariate analysis showed that there was a statistically significant difference between groups in tPSA,PSAD,NLR,SⅡ,DD,ALP,sCa,Glea-son,and cTx.Multivariate logistic regression analysis showed that PSAD,DD,ALP,Gleason,and cTx were independent risk factors in the development of bone metastases in prostate cancer.When the five independent risk factor were used to construct a prediction model,the AUC of the model was 0.973(95％CI:0.955-0.991),and the AUCs of each individual independent risk factor were 0.853,0.886,0.873,0.813,and 0.842.The model was significantly higher than each individual independent risk factors and had the best predictive effect on the development of bone metastases in prostate cancer.When all independent risk factors were set to negative values,a total of 65 patients were selected.None of these patients had bone me-tastases.There were also 65 patients without bone metastases,meaning the false negative rate was 0(0/65).Considering that 31.9％(65/204)of patients did not need bone imaging,the model was validated using 23 external data sets.The sensitivity and specificity were 90.9％(10/11)and 91.7％(11/12),respectively,which were basically consistent with the model's sensi-tivity of 91.5％and specificity of 93.4％.The model was found to have good accuracy and stability.Conclusions PSAD,DD,ALP,Gleason,and cTx are independent risk factors in bone metastases in prostate cancer.The constructed nomogram model has a high predictive value for bone metastases of prostate cancer.
维普
万方数据