摘要
目的探讨列线图模型对胆管癌介入治疗预后评估的临床价值和效能。方法回顾性分析2014年1月至2021年6月在郑州大学第一附属医院接受介入治疗的259例胆管癌患者临床资料,其中男148例,女111例,年龄26~91(65±12)岁。按7∶3的比例分为训练组(181例)和验证组(78例)。在训练组中进行Cox回归分析,筛选出影响患者预后的相关危险因素,构建患者6个月、1年及2年生存率的列线图预测模型,通过计算受试者工作特征曲线下面积(AUC)、校准曲线和决策曲线分析模型性能,并在验证组中评估模型的预测效能。结果训练组和验证组基线资料差异无统计学意义,具有可比性。回归分析显示:T分期(T2:HR=0.147,95%CI:0.077~0.281;T3:HR=0.207,95%CI:0.122~0.351;T4:HR=0.864,95%CI:0.537~1.393)、肿瘤直径(17~33 mm:HR=0.201,95%CI:0.119~0.341;≥33 mm:HR=0.795,95%CI:0.521~1.211)及分化程度(中分化:HR=3.318,95%CI:2.082~5.289;高分化:HR=1.842,95%CI:1.184~2.867)是影响胆管癌介入治疗预后的危险因素。训练组和验证组生存率列线图预测模型的AUC基本一致,训练组6个月、1年、2年后AUC分别为0.925(95%CI:0.888~0.963)、0.921(95%CI:0.877~0.964)、0.974(95%CI:0.957~0.993);验证组6个月、1年、2年的AUC分别为0.951(95%CI:0.911~0.991)、0.917(95%CI:0.857~0.977)、0.848(95%CI:0.737~0.959),AUC均>0.8。两组生存率列线图预测模型的校准曲线基本相符,且在6个月、1年的校准曲线走形均与理想曲线基本拟合,而2年校准曲线拟合度则相对较差。结论T分期、肿瘤直径及分化程度是影响经介入治疗胆管癌患者预后的危险因素,本列线图模型对其预后评估有着较好的区分能力及一定的临床价值。
Objective To investigate the clinical value and efficacy of the nomogram model in evaluating the prognosis of cholangiocarcinoma after interventional therapy.Methods The clinical data of 259 patients with cholangiocarcinoma who received interventional therapy at the First Affiliated Hospital of zhengzhou University from January 2014 to June 2021 were retrospectively analyzed,including 148 males and 111 females,aged from 26 to 91(65±12)years.They were randomly divided into a training group(181 cases)and a validation group(78 cases)in a ratio of 7∶3.Cox regression analysis was performed in the training group,independent risk factors affecting the prognosis of patients were screened,and a nomogram for 6-month,1-year,and 2-year survival was constructed.The performance of the nomogram was analyzed by calculating the area under the receiver operating characteristic curve(AUC)value,calibration curve,and decision curve,and the predictive efficacy of the model was evaluated in the validation group.Results There was no significant difference in baseline data between the training group and the validation group,which was comparable.Regression analysis showed that T stage(T2:HR=0.147,95%CI:0.077-0.281;T3:HR=0.207,95%CI:0.122-0.351;T4:HR=0.864,95%CI:0.537-1.393),tumor diameter(17-33 mm:HR=0.201,95%CI:0.119-0.341;≥33 mm:HR=0.795,95%CI:0.521-1.211)and differentiation degree(middle differentiation:HR=3.318,95%CI:2.082-5.289;highly differentiation:HR=1.842,95%CI:1.184-2.867)were risk factors affecting the prognosis of interventional therapy for cholangiocarcinoma.The AUC values of the survival curve prediction models were generally consistent between the training and validation groups,and the AUC values of the training group at 6 months,1 year,and 2 years were 0.925(95%CI:0.888-0.963),0.921(95%CI:0.877-0.964)and 0.974(95%CI:0.957-0.993),respectively.In the validation group,the 6-month,1-year,and 2-year AUC values were 0.951(95%CI:0.911-0.991),0.917(95%CI:0.857-0.977)and 0.848(95%CI:0.737-0.959),respectively,and the AUC values were all greater than 0.8,suggesting that the nomogram had better discrimination ability.The calibration curves of the prediction models of the two groups were basically consistent,and the shape of the calibration curves at 6 months and 1 year fitted the ideal curve,while the fitting degree of the calibration curves at 2 years was relatively poor.The decision curve showed the high clinical utility of this nomogram in predicting the 6-month,1-year survival of patients with cholangiocarcinoma.Conclusions T stage,tumor diameter,and differentiation are independent risk factors affecting the prognosis of patients with interventional cholangiocarcinoma,and the nomogram model proposed in this study has good distinguishing ability and exact clinical value for prognosis evaluation.
作者
李臻
谢炳灿
吕培杰
王会霞
李岩
王彩鸿
李鑫
叶书文
李刚
庞鹏飞
张玉元
余鹏
Li Zhen;Xie Bingcan;Lyu Peijie;Wang Huixia;Li Yan;Wang Caihong;Li Xin;Ye Shuwen;Li Gang;Pang Pengfei;Zhang Yuyuan;Yu Peng(Department of Interventional Radiology,the First Affiliated Hospital of Zhengzhou University,Engineering Technology Research Center for Minimally Invasive Interventional Tumors of Henan Province,Zhengzhou 450052,China;Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Cardiology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Department of Magnetic Resonance,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Interventional Radiology,Zhengzhou First People′s Hospital,Zhengzhou 450004,China;Department of Interventional Radiology,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第16期1217-1224,共8页
National Medical Journal of China
基金
河南省部共建重点科研项目(SBGJ202102099)
河南省高等学校重点科研项目(22A320057)
关键词
胆管肿瘤
介入治疗
列线图
预测模型
横断面研究
Bile duct neoplasms
Interventional therapy
Nomogram
Prediction model
Cross-sectional study
作者简介
通信作者:李臻,Email:lzlyct620@163.com
