肺楔形切除术治疗非小细胞肺癌的疗效及术后复发风险模型的构建

Effect of lung wedge resection in the treatment of non・small cell lung cancer and the construction of postoperative recurrence risk model

目的探究肺楔形切除术治疗非小细胞肺癌(NSCLC)的疗效及术后复发的危险因素,构建风险预测模型。方法回顾性分析2018年6月-2020年6月绵阳市中心医院收治的126例NSCLC患者的临床资料,根据手术方式的不同,将患者分为肺楔形切除术组(n=88)和肺叶切除术组(n=38)。比较2种手术术后1年转移率、复发率和病死率;根据肺楔形切除术组患者术后1年的复发情况分为复发组(n=15)和非复发组(n=73),比较两组患者一般资料、术前实验室检查指标;多因素Logistic分析影响患者术后复发的因素;构建风险评分模型并评价其预测价值。计数资料采用例数和百分数(%)表示,组间对比采用χ2检验。多因素Logisitic回归分析影响NSCLC患者肺楔形切除术术后1年复发的影响因素;根据危险因素,构建风险评分模型,采用X-tile软件获得评分的截断值;校准曲线评价风险预测模型预测的准确性,临床决策曲线评价模型预测的有效性。结果肺楔形切除术组患者术后1年的手术切缘转移率、病死率分别为0、6.82%,肺叶切除术组分别为13.16%、21.5%,两组相比差异具有统计学意义(P<0.05);复发组吸烟史、脉管栓癌、淋巴结清扫个数≤15个、癌胚抗原>5 ng/mL、中性粒细胞与淋巴细胞比值>2.5、可溶性CD105>4 ng/mL、血管内皮生长因子>9 ng/mL、基质金属蛋白酶9>300μg/L的患者比例明显高于非复发组,均是导致肺楔形切除术术后复发的危险因素(P<0.05);将上述危险因素纳入风险评分模型,分别赋予22、38、25、33、20、27、36、30分的权重,根据截断值可将患者划分为中危患者(≤78分)、高危患者(>78分且≤162分)和极高危患者(>162分)。结论胸腔镜下肺楔形切除术治疗NSCLC的效果明显优于胸腔镜下肺叶切除术,构建预测患者术后复发的风险评分模型有利于临床上早期识别高危人群,指导医护人员采取个性化的治疗和护理措施。

Objective Explore the efficacy of pulmonary wedge resection in the treatment of non-small cell lung cancer(NSCLC)and risk factors for postoperative recurrence,anti construct a risk prediction model.Methods A retrospective analysis of the clinical data of 126 NSCLC patients were admitted to Mianyang Central Hospital from June 2018 to June 2020.According to different surgical methods,the patients were divided into pulmonary wedge resection group(n=88)and lobectomy Group(n=38).Compare the metastasis rate,recurrence rate,and fatality rate at 1 year after the two kinds of operations;according to the recurrence of the lung wedge resection group,the patients are divided into recurrence group(n=15)and non-recurrence group(n=73).The general data and preoperative laboratory examination indexes of the two groups of patients were compared;multivariate Logistic analysis of factors affecting postoperative recurrence of patients;a risk scoring model was constructed and its predictive value was evaluated.Enumeration data was expressed by the number of cases and percentage(%),and the comparison between groups was performed by chi-square test.Multivariate Logisitic regression analysis of factors affecting the recurrence of NSCLC patients at 1 year after pulmonary wedge resection;a risk scoring model was constructed according to risk factors,and X-tile software was used to obtain the cutoff value of the score;a calibration curve was used to evaluate the accuracy of the risk prediction model prediction The clinical decision curve evaluates the effectiveness of model predictions.Results The surgical margin metastasis rate and mortality of patients in the pulmonary wedge resection group were 0 and 6.82%,and the lobectomy group were 13.16% and 21.05%,respectively.The differences between the two groups were statistically significant(P<0.05);The proportion of patients with smoking history,vascular thrombus cancer,lymph node dissection ≤15,carcinoembryonic antigen>5 ng/mL,neutrophil to lymphocyte ratio>2.5,soluble CD 105>4 ng/mL,vascular endothelial growth factor>9 ng/mL and matrix metalloproteinase 9(MMP-9)>300μg/L in recurrent group were significantly higher than those in non-recurrent group.All of them were risk factors for recurrence after wedge pneumonectomy(P<0.05);the above risk factors were incorporated into the risk scoring model,and weights of 22,38,25,33,20,27,36,and 30 were assigned respectively,and patients were classified as medium according to the cut-off value.Risk patients(≤78 points),high-risk patients(>78 points and ≤162 points),and extremely high-risk patients(>162 points).Conclusions The effect of thoracoscopic wedge resection in the treatment of NSCLC is significantly better than that of thoracoscopic lobectomy.The construction of a risk scoring model for predicting postoperative recurrence of patients is beneficial to early identification of high-risk groups in clinical practice,and to guide medical staff to adopt personalized treatment and nursing care measures.