基于合成少数过采样技术算法构建肝癌术后合并胆漏的预警模型
A synthetic minority oversampling technique-based early warning model of postoperative biliary leak-age after resection for hepatocellular carcinoma
宋林泉 1梁志宏1
作者信息
- 1. 中山市小榄人民医院肝胆外科,中山 528415
- 折叠
摘要
目的 分析肝癌患者腹腔镜肝叶切除术后合并胆漏的影响因素,并基于合成少数过采样技术(SMOTE)构建肝癌患者术后合并胆漏的预警模型.方法 回顾性分析2016年1月至2022年1月在中山市小榄人民医院行腹腔镜肝叶切除术的120例肝癌患者的临床资料,其中男性72例,女性48例,年龄(58.6±6.7)岁.根据患者术后1个月胆漏发生情况分为两组:胆漏组(n=32)和非胆漏组(n=88).收集患者的病灶长径、余肝体积、术中出血量、丙氨酸氨基转移酶(ALT)以及天冬氨酸氨基转移酶(AST)等临床资料.根据SMOTE算法对原始数据集中的阳性样本量进行扩充,并基于新数据集构建SMOTE风险预警模型(P2).受试者工作特征(ROC)曲线分析模型对胆漏的预测效能,并计算曲线下面积(AUC).结果 120例肝癌患者术后有32例患者出现胆漏,88例患者未出现胆漏,胆漏发生率为26.67％(32/120).胆漏组和非胆漏组患者的病灶长径、术前合并胆管炎、余肝体积、术中出血量、ALT以及AST对比,差异均具有统计学意义(均P＜0.05).通过SMOTE算法将胆漏组样本数量扩充至96例,此时胆漏组和非胆漏组中的样本量比值接近于1.随后对基于SMOTE算法扩充后的数据重新拟合,结果显示,病灶长径≥5 cm、术前合并胆管炎、术中出血量增加、ALT升高及AST升高均是肝癌患者术后合并胆漏的独立危险因素(均P＜0.05),而余肝体积越大是肝癌患者术后合并胆漏的保护因素(P＜0.05).基于SMOTE建立了预警模型P2,Hosmer-Lemeshow检验结果显示,模型拟合度良好(P=0.842,决定系数R2=0.647),对肝癌患者术后合并胆漏预测的灵敏度为93.75％,特异度为82.95％,AUC为0.955(95％CI:0.901～0.985).结论 病灶长径、术前合并胆管炎、余肝体积、术中出血量、ALT以及AST均与肝癌患者术后合并胆漏密切相关.基于SMOTE算法构建的肝癌术后合并胆漏的预警模型具有较高的预测效能.
Abstract
Objective To analyze the influencing factors of postoperative bile leakage in laparo-scopic liver lobectomy for hepatocellular carcinoma(HCC),and to create and validate an early warning model of postoperative bile leakage based on the synthetic minority oversampling technique(SMOTE).Methods Clinical data of 120 patients with HCC undergoing laparoscopic lobectomy in Xiaolan People's Hospital of Zhongshan City from January 2016 to January 2022 were retrospectively analyzed,including 72 males and 48 females,aged(58.6±6.7)years old.The patients were divided into two groups according to the occurrence of bile leakage within 30 days after surgery:bile leakage group(n=32)and non-bile leakage group(n=88).Clinical data such as lesion size,remnant liver volume,intraoperative blood loss,and serum levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were collected.The positive sample size in the original dataset was expanded according to the SMOTE algorithm,and the SMOTE risk warning model(P2)was established based on the new dataset.The predictive eficacy of the model was accessed using the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results The incidence of postoperative bile leakage was 26.67％(32/120)in the patients.Lesion size,preoperative cholangitis,remnant liver volume,intraoperative blood loss,serum level of ALT and AST differs between the groups(all P＜0.05).The sample size of the bile leakage group was expanded to 96 cases by the SMOTE algorithm,and then the sample size ratio of the two groups would be close to 1.Subse-quent re-fitting of the expanded data based on the SMOTE algorithm showed that a lesion size of ≥5 cm,preoperative cholangitis,increased intraoperative hemorrhage,elevated ALT and AST were independent risk factors for postoperative bile leakage in patients with HCC(all P＜0.05),while a larger remnant liver volume was a protective factor for postoperative bile leakage(P＜0.05).An early warning model P2 was established based on the above factors.The Hosmer-Lemeshow test showed that the model fitting was good(P=0.842,coefficient of determination R2=0.647).The sensitivity and specificity of the model for predicting postopera-tive bile leakage was 93.75％and 82.95％,respectively,with an AUC of 0.955(95％CI:0.901-0.985).Conclusion Lesion size,preoperative cholangitis,remnant liver volume,intraoperative blood loss,serum levels of ALT and AST were associated with postoperative bile leakage after surgery for HCC.The early warning model of postoperative bile leakage based on the SMOTE algorithm has a high predictive efficacy.
关键词
肝肿瘤/术后合并胆漏/危险因素/预警模型Key words
Liver neoplasms/Postoperative combined bile leak/Risk factors/Early warning models引用本文复制引用
出版年
2024
NETL
NSTL
万方数据