目的 通过对临床常规检验指标进行数据分析,筛选出对低癌胚抗原(carcinoembryonic antigen,CEA)结直肠癌具有潜在诊断价值的指标,构建列线图预测模型,并验证该模型的预测效能.方法 选取2019年9月～2023年12月安徽医科大学附属巢湖医院收治的低CEA结直肠癌患者194例设为低CEA结直肠癌组,另外选取同期结直肠良性疾病患者184例作为非结直肠癌组.先对两组的临床常规检验指标包括血常规、生化常规、凝血功能及肿瘤标志物进行单因素分析,然后筛选出差异有统计学意义(P＜0.05)的指标,进一步进行多因素Logistic分析,得出低CEA结直肠癌发生的独立影响因素;采用R 4.3.3软件建立列线图预测模型,运用Bootstrap法重复抽样1000次对列线图预测模型进行内部验证,绘制受试者工作特征(receiver operat-ing characteristic,ROC)曲线、Calibration校准曲线、决策曲线分析(decision curve analysis,DC A)评价模型的区分度、校准度以及临床实用性.结果 多因素Logistic回归分析结果显示,血红蛋白与红细胞分布宽度比值(hemoglobin-to-erythrocyte distribution width ratio,HRR)、血白蛋白(albumin,ALB)及CEA是低CEA结直肠癌的独立影响因素.ROC曲线分析结果显示,三者联合预测模型的曲线下面积(area under the curve,AUC)为 0.822(95％CI:0.781～0.864),敏感度为 71.10％,特异性为 79.90％,运用Bootstrap法进行内部验证并绘制Calibration校准曲线及决策曲线分析提示该列线图模型区分度、一致性及临床效能较好.结论 HRR、ALB及CEA对低CEA结直肠癌具有一定的诊断价值,三者联合的诊断效能较高,基于这3项血清学指标构建的风险预测列线图模型具有较好的临床应用前景.
Construction of A Low CEA Colorectal Cancer Nomogram Model Based on HRR,ALB and CEA
Objective To analyze the data of routine clinical indicators,screen out the indicators with potential diagnostic value for low carcinoembryonic antigen(CEA)colorectal cancer,and construct a nomogram prediction model,and verify the predictive efficacy of the model.Methods A total of 194 colorectal cancer patients with low CEA admitted to Chaohu Hospital of Anhui Medical University from September 2019 to December 2023 were selected to be set as the low CEA colorectal cancer group,and another 184 patients with be-nign colorectal diseases in the same period were selected as the non-colorectal cancer group.Univariate analysis was used to find out the indicators with differences(P＜0.05)in the routine clinical tests including routine blood,biochemical routine,coagulation function and tumor markers in the two groups,and then multivariate logistic analysis was used to find out the independent influencing factors for the oc-currence of low CEA colorectal cancer;R4.3.3software was used to establish the nomogram prediction model,and Bootstrap method was used to repeat the sampling 1000 times for the internal validation of the nomogram prediction model,and the receiver operating characteris-tic(ROC)curve,Calibration curve,and decision curve analysis(DCA)were plotted to evaluate the differentiation and calibration of the model,as well as the clinical practicability of the model.Results The results of multivariate logistic regression analysis show that hemo-globin-to-erythrocyte distribution width ratio(HRR),blood albumin(ALB)and CEA were independent influences in colorectal cancer with low CEA,and ROC curve analysis show that the area under the curve(AUC)of the predictive model was 0.822(95％CI:0.781-0.864),the sensitivity was 71.10％,the specificity was 79.90％,internal validation using Bootstrap method and plotting of Calibration calibration curve and decision curve analysis suggested that the nomogram prediction model had good discrimination,consistency and clini-cal efficacy.Conclusion HRR,ALB and CEA have certain diagnostic value for colorectal cancer with low CEA,and their combined di-agnostic efficacy is high,and the risk prediction nomogram model constructed on the basis of these three serologic indexes has a good clini-cal application prospect.
Hemoglobin-to-erythrocyte distribution width ratioCarcinoembryonic antigenColorectal cancerN omogramPre-diction model
万方数据
维普
