ⅠA期非小细胞肺癌术后复发的临床预测模型建立

Establishment of Clinical Predictive Model of Postoperative Recurrence of Non-Small Cell Lung Cancer in ⅠA Stage

目的 探讨影响ⅠA期非小细胞肺癌(NSCLC)患者术后复发危险因素并构建临床预测模型.方法 采用回顾性研究方法 .收集2008年1月—2012年11月行手术切除并且经病理确诊为ⅠA期NSCLC 471例患者的临床资料,并对其进行预后分析.采用电话、门诊进行随访,以了解患者术后复发情况,随访时间截至2017年11月.采用Kaplan-Meier法绘制生存曲线;采用COX比例风险模型进行单因素及多因素分析筛选危险因素,建立ⅠA期NSCLC患者术后复发预测模型.根据COX模型中入选变量回归系数等信息绘制患者术后5年生存率列线图及校正曲线.结果 该研究471例IA期NSCLC患者术后5年总体复发率19.1%;影响ⅠA期NSCLC患者术后复发的危险因素:单因素分析结果 显示性别(P=0.001)、年龄(P<0.001)、术前NLR(P<0.001)、术前血清CEA水平(P=0.004)、分化程度(P<0.05)、T分期(P<0.05),与ⅠA期NSCLC患者术后复发相关;多因素分析结果 显示年龄>65岁(P<0.001)、肿瘤越大(P<0.05)、术前NLR>2.5(P=0.011)、术前CEA>2.5 ng/mL(P=0.023)、分化程度低(P<0.05)是ⅠA期NSCLC患者术后复发的独立危险因素;通过变量筛选,最终模型包括年龄、T分期、术前NLR、术前CEA、分化程度,并以此绘制列线图.模型的内部验证显示该列线图具有较好的区分度(C-index=0.69)和一致性.结论 年龄>65岁、肿瘤越大、术前NLR>2.5、术前CEA>2.5 ng/mL、分化程度低是ⅠA期NSCLC患者术后复发的独立危险因素.构建的列线图可以判定该期患者术后复发的几率,有助于对ⅠA期NSCLC患者术后的个体化治疗进行决策.

Objective To investigate the risk factors of postoperative recurrence of non-small cell lung cancer(NSCLC)in ⅠA stage,and draw a nomogram clinical model.Methods The retrospective study was conducted.The clinical data of 471 patients who underwent surgical resection and were diagnosed as ⅠA stage by pathology between January 2008 and November 2012 were collected.The clinical data of patients were used for prognostic analysis.The follow-up using telephone interview and visit was performed to detect the postoperative recurrence of NSCLC in ⅠA stage up to December 2017.The survival curve was drawn by the Kaplan-Meier method.Univariate and multivariate COX regression analysis the value of factors in predicting the probability of NSCLC in ⅠA stage.A risk model of postoperative recurrence of NSCLC in ⅠA stage was built.The nomogram model and calibration curve of postoperative survival rate in 5 years were drawn according to the regression coefficients and other data of selected variables in the COX regression model.Results The total recurrence rate of 471 patients with ⅠA-stage NSCLC in 5 years after operation was 19.1%.Risk factors analysis affecting the postoperative recurrence of NSCLC in ⅠA stage:In univariate COX regression analysis,sex(7=0.001),age(P<0.001),preoperative NLR(P<0.001),preoperative serum CEA level(P=0.004),differentiation degree(P<0.05),T stage(P<0.05),were significantly associated with postoperative recurrence of patients with ⅠA stage NSCLC.In multivariate analysis,only age>65 years old(P<0.001),the bigger the tumor(P<0.05),preoperative NLR>2.5(P=0.011),preoperative serum CEA level>2.5 ng/mL(P=0.023),low differentiation(P<0.05)retained independent significance.Through variable filtering,the final model includes age,T stage,preoperative NLR,preoperative serum CEA level,differentiation degree,and to draw a nomogram.The nomogram predicting the risk of postoperative recurrence of NSCLC in ⅠA stage showed relative good concordance index(0.69)and good calibration.Conclusion Age>65 years old,the bigger the tumor,preoperative NLR>2.5,preoperative serum CEA level>2.5 ng/mL,low differentiation are independent risk factors affecting the postoperative recurrence of NSCLC in ⅠA stage.The nomogram can assess the postoperative recurrence risk of this patients.This statistical tool may facilitate discussions at the point of treatment decision making.