肺癌患者胸腔镜术后胸腔积液发生的列线图预测模型构建

Construction of Nomogram Prediction Model for Pleural Effusion After Video-assisted Thoracic Surgery in Patients with Lung Cancer

目的分析肺癌患者胸腔镜手术(VATS)后胸腔积液发生的影响因素,并绘制列线图,构建预测模型。方法选取532例肺癌患者作为研究对象,询问并记录患者基线资料,根据患者术后胸腔积液发生情况分为发生组和未发生组。对比两组基线资料,经Logistic回归分析检验肺癌患者VATS术后胸腔积液发生的影响因素,并绘制列线图构建胸腔积液风险预测模型。结果532例肺癌患者VATS后,60例发生胸腔积液,占11.28%;发生组年龄≥60岁、糖尿病、吸烟史、低白蛋白血症、1 s用力呼气容积(FEV1)占预计值百分比≤60%占比高于未发生组,降钙素原(PCT)水平高于未发生组,差异有统计学意义(P<0.05);组间其他基线资料对比差异无统计学意义(P>0.05);经Logistic回归分析,P值放宽至<0.1,建立多元回归模型,结果显示,高龄、合并糖尿病、吸烟史、低白蛋白血症、PCT水平高、FEV1%≤60%是肺癌患者VATS术后胸腔积液发生的风险因子(OR>1,P<0.05);构建术后发生胸腔积液风险预测模型,经Bootstrap法重复抽样1000次验证模型,结果显示,C-index值为0.909,模型区分度良好;绘制准曲线显示,校准曲线Y与X直线相近,模型准确度良好;绘制ROC曲线发现,胸腔积液预测模型得到的预测值用于预测肺癌患者VATS后胸腔积液发生风险的AUC>0.90,有较好预测价值。结论肺癌患者VATS术后胸腔积液的发生与高龄、合并糖尿病、吸烟史、低白蛋白血症、PCT水平高、FEV1%有关,根据上述因素构建胸腔积液风险预测模型具有较好预测价值。

Objective To analyze the influencing factors of pleural effusion after video-assisted thoracic surgery(VATS)in patients with lung cancer,and to draw a nomogram and build a prediction model.Methods 532 patients with lung cancer were selected as the research subjects,asked and recorded the baseline data of patients,according to the occurrence of postoperative pleural effusion of patients,they were divided into occurrence group and non occurrence group.Compared the baseline data of the two groups,Logistic regression analysis was used to test the influencing factors of pleural effusion after VATS in patients with lung cancer,and the nomogram was drawn to construct the risk prediction model of pleural effusion.Results After VATS,pleural effusion occurred in 60 of 532 patients with lung cancer,accounting for 11.28%;the proportion of age>60 years old,diabetes mellitus,smoking history,hypoalbuminemia,percentage for the estimated value of 1s forced expiratory volume(FEV1)≤60%of the occurrence group was higher than that of the non occurrence group,the level of procalcitonin(PCT)was higher than that of the non occurrence group,the differences were statistically significant(P<0.05).There was no statistical significant difference in other baseline data between groups(P>0.05);through Logistic regression analysis,the P value was relaxed to<0.1,and a multiple regression model was established,the results showed that older age,combined with diabetes mellitus,smoking history,hypoalbuminemia,high level of PCT and FEV1%<60%were risk factors for pleural effusion after VATS in patients with lung cancer(OR>1,P<0.05).The risk prediction model of postoperative pleural effusion was constructed,and the model was verified by repeated sampling 1000 times by Bootstrap method,the results showed that the c-index value was 0.909,and the model discrimination was good;the drawn quasi curve showed that the calibration curve Y was close to the straight line X,and the accuracy of the model was good;the ROC curve was drawn and showed that the AUC of the predicted value of the pleural effusion prediction model used to predict the risk of pleural effusion after VATS in patients with lung cancer was>0.90,which had good predictive value.Conclusion The occurrence of pleural effusion after VATS in patients with lung cancer is related to age,diabetes mellitus,smoking history,hypoalbuminemia,PCT level and FEV1%,the risk prediction model of pleural effusion based on the above factors has good prediction value.