慢性阻塞性肺疾病并发肺癌的相关危险因素分析及Nomogram模型的构建

Analysis of risk factors and Nomogram model of COPD patients complicated with lung cancer

目的通过构建Nomogram模型对慢阻肺(COPD)患者并发肺癌的相关危险因素进行预测。方法回顾性分析浙江省绍兴文理学院附属医院193例COPD并发肺癌患者,对患者的信息中可能成为危险因素的数据进行Logistics回归分析,并以此为基础构建Nomogram模型。结果BMI>23.73kg/m^(2)、病程>13年、淋巴细胞计数≤1.23×10^(9)/L、NLR>2.68、PLR>162.34、血清趋化因子CCL18>100.4ng/mL、血清趋化因子CCL21>228.1ng/mL是慢阻肺患者并发肺癌发生的独立危险因素(P<0.05);Nomogram模型校正曲线及临床净收益分析:内部验证结果显示Nomogram模型预测预测COPD患者并发肺癌风险C-index为0.687(95%CI:0.656-0.769)。Nomogram模型预测COPD患者并发肺癌发生风险阈值>0.16。此外,Nomogram模型临床净收益均高于BMI、病程、淋巴细胞计数、NLR、PLR、血清趋化因子CCL18、血清趋化因子CCL21。结论基于COPD并发肺癌的危险因素构建的Nomogram模型对临床COPD并发肺癌的临床预估具有前瞻性。

Objective To predict the related risk factors of lung cancer in patients with chronic obstructive pulmonary disease(COPD)by constructing nomogram model.Methods 193 patients with COPD complicated with lung cancer in the Affiliated Hospital of Shaoxing University of Arts and Sciences in Zhejiang Province were retrospectively analyzed.Logistic regression analysis was performed on the data that may be risk factors in the patient information,and nomogram model was constructed on this basis.Results BMI>23.73kg/m^(2)、course of disease>13 years、lymphocyte count≤1.23×10^(9)/L、NLR>2.68、PLR>162.34、serum chemokine CCL18>100.4ng/mL、serum chemokine CCL21>228.1ng/mL were independent risk factors for COPD patients complicated with lung cancer(P<0.05);Nomogram model correction curve and clinical net income analysis:internal validation results show that nomogram model predicts the risk of lung cancer in COPD patients with c-index of 0.687(95%CI:0.656-0.769).Nomogram model predicts that the risk threshold of COPD patients complicated with lung cancer is>0.16.In addition,the clinical net income of nomogram model is higher than BMI、course of disease、lymphocyte count、NLR、PLR、serum chemokine CCL18、serum chemokine CCL21.Conclusion The nomogram model based on the risk factors of COPD complicated with lung cancer is prospective for the clinical prediction of COPD complicated with lung cancer.