散发性年轻结直肠癌系膜转移列线图预测模型的构建

The construction of nomogram prediction model of mesentery metastasis in sporadic young colorectal cancer

目的 探讨散发性年轻结直肠癌系膜转移的危险因素,并应用列线图构建预测模型.方法 采用回顾性病例对照研究的方法,收集2010年1月至2020年12月在宁波市医疗中心李惠利医院接受手术治疗的109例散发性年轻结直肠癌患者的临床病理资料.应用单因素分析和多因素Logistic回归分析筛选独立危险因素,并采用独立危险因素构建散发性年轻结直肠癌系膜转移列线图预测模型.运用C指数、ROC曲线、校准曲线及临床决策曲线评价模型的区分度、校准度和临床效益.结果 单因素分析结果显示,散发性年轻结直肠癌发生系膜转移与性别、组织病理学分级、浸润深度、脉管癌栓、神经侵犯、术前CEA值、术前CA199值、MMR状态相关(P<0.05).多因素分析显示,组织病理学分级为高级别、有脉管癌栓、术前CEA值>5μg/L、术前CA199值>37U/mL是影响散发性年轻结直肠癌系膜转移的独立危险因素(P<0.05).因术前无法明确脉管癌栓情况,遂将组织病理学分级、术前CEA值和术前CA199值纳入R软件构建系膜转移列线图预测模型.模型的C指数为0.719(95%CI:0.620~0.817),ROC曲线下面积为0.719,提示模型预测能力良好.校准曲线和临床决策曲线显示模型一致性和临床获益良好.结论 本研究建立了基于3项临床病理因素的散发性年轻结直肠癌系膜转移列线图预测模型,对临床医师术前制定合理的治疗方案有一定参考价值.

Objective To explore the independent risk factors of mesentery metastasis in sporadic young colorectal cancer,and to construct is nomogram predicion model before operation.Methods A retrospective case-control study was conducted.The clinicopathologial data of 109 young patients with sporadic colorectal cancer receiving operation in Lihuili Hospital from 2010 to 2020 were collected,including 66 males and 43 females,aged from 16 to 40.Among them,49 cases had mesentery metastases and 60 cases had no mesentery metastases.Univariate analysis and multivariate logistic regresion were used to screen independent risk factors.Based on results of mulivariate analysis,a nomogram model for predicting mesentery metastasis of young sporadic colorectal cancer was constructed.The C index,ROC curve,and calibration curve were used to evaluate the predictive ability of the model.The clinical benefit was evaluated by decision curve analyss.Results Univariate analysis showed gender,histopathological grade,depth of invasion,vascular tumor thrombus,nerve invasion,preoperative CEA,preoperative CA199 and MMR status were asociated with mesentery metastasis in sporadic young colorectal cancer(P<0.05),Mulivariate analysis showed only poor diferentiation,vascular tumor thrombus,preoperative CEA>5μg/L and preoperative CA199>37/mL were independent risk factors(P<0.05).As the condition of vasular tumor thrombus could not be clarifed before operation,histopathological grade,preoperative CEA and preoperative CA199 were selected to construct the nomogram prediction model finlly.The C index of the model was 0.719(95%CI:0.620~-0.817),and the area under the ROC curve was 0.719 consistently.The calibration curve showed a good consstency between the probability predicted by the model and the actual situation.The decision curve analysis indicated that the model had good clinical benefit.Conclusion The nomogram model can effectively predict the probability of mesentery metastasis in sporadic young colorectal cancer and has a certain reference value for clinicians before surgery.