摘要
目的分析影响经手术切除后肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)患者无进展生存期(progression-free survival,PFS)的危险因素,并基于血液检测指标构建预测列线图模型。方法选取2020年1月至2022年12月在湖南省人民医院进行首次治疗的99例ICC患者作为研究对象,分为训练组(n=70)与验证组(n=29)。采用最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)回归分析与多元Cox风险回归分析术后复发的独立危险因素并构建列线图。通过一致性指数、受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)、校准曲线、决策曲线分析和无进展生存曲线进一步测试其准确性和临床实用性。结果LASSO与多元Cox风险回归分析表明患者的性别、肿瘤-淋巴结-转移、分化程度、肿瘤直径、天冬氨酸转氨酶、甲胎蛋白、术后总胆汁酸和手术前后的单核细胞变化是影响ICC患者PFS的独立因素。基于危险因素构建的预测模型显示训练组一致性指数为0.884,验证组为0.838。ROC曲线下面积:训练组6个月、1年和2年的PFS预测分别为0.972,0.965和0.923;验证组6个月、1年和2年的PFS预测分别为0.972,0.821和0.923。根据列线图计算的风险评分将ICC患者分为术后复发高风险组和低风险组,高风险组中位PFS显著短于低风险组(P<0.05)。结论本研究构建的列线图具有良好的预测效果,可作为预测ICC患者术后PFS的补充评估。
Objective To analyze the risk factors affecting the progression-free survival(PFS)of patients with intrahepatic cholangiocarcinoma(ICC)after surgical resection,and a predictive nomogram model was constructed based on blood test indicators.Methods A total of 99 ICC patients who received their first treatment at Hunan Provincial People’s Hospital from January 2020 to December 2022 were selected as research subjects,they were divided into training group(n=70)and validation group(n=29).The independent risk factors for postoperative recurrence were identified using least absolute shrinkage and selection operator(LASSO)regression analysis and multivariate Cox risk regression analysis.The accuracy and clinical utility of the method were further tested by consistency index,receiver operating characteristic(ROC)curve,calibration graph,decision curve analysis,and progression-free survival curve.Results LASSO and multivariate Cox risk regression analysis showed that patient’s gender,tumor-lymph node metastasis,differentiation grade,tumor diameter,aspartate aminotransferase,alpha-fetoprotein,total bile acid after surgery,and monocyte changes before and after surgery were independent factors affecting the PFS of ICC patients.The predictive model based on the risk factor showed that the consistency index of the training group was 0.884 and that of the validation group was 0.838.The area under ROC curve for training group:PFS prediction at 6 months,1 year,and 2 years were 0.972,0.965 and 0.923,respectively;for validation group:PFS prediction at 6 months,1 year,and 2 years were 0.972,0.821 and 0.923,respectively.The risk score calculated according to the nomogram divided ICC patients into high-risk group and low-risk group with high postoperative recurrence risk,and the median PFS in high-risk group was significantly shorter than that in low-risk group(P<0.05).Conclusion The nomogram constructed by this study has good predictive effect and can be used as a supplementary evaluation for predicting PFS after ICC patients.
作者
段洁
陈杰
吴思弦
彭莉蓉
DUAN Jie;CHEN Jie;WU Sixian;PENG Lirong(Department of Clinical Laboratory,Hunan Provincial People’s Hospital(the First-affiliated Hospital of Hunan Normal University),Changsha 410005,Hunan,China)
出处
《中国现代医生》
2025年第17期8-11,共4页
China Modern Doctor
基金
湖南省自然科学青年基金(2022JJ40223)
湖南省教育厅优秀青年基金(22B0057)
湖南省人民医院博士基金(BSJJ202110)。
关键词
肝内胆管癌
无进展生存期
列线图
诊断模型
Intrahepatic cholangiocarcinoma
Progression-free survival
Nomogram
Diagnostic model
作者简介
通信作者:彭莉蓉,电子信箱:836533071@qq.com。
