化疗相关性恶心和呕吐风险预测模型的构建

Development of a risk prediction model for Chemotherapy-Induced Nausea and Vomiting

目的:构建化疗相关性恶心和呕吐(CINV)风险预测模型,为预防CINV提供依据。方法:基于系统文献检索法筛选CINV高危风险因素,于2020年9月至2021年5月在重庆市12所三级甲等医院肿瘤科对化疗患者进行调查,采用癌症支持治疗多国协作组止吐评价工具(MAT)中文版评估CINV发生情况,以未发生呕吐或MAT中恶心数字评分<3分为结局指标,采用多因素Logistic回归分析CINV独立风险因素,受试者工作特征(ROC)曲线分析评价CINV风险预测模型的预测效能、敏感度及特异性。结果:2215例患者中,发生呕吐或MAT中恶心数字评分≥3分的有639例(28.8%)。多因素Logistic回归分析筛选出11项CINV独立风险因素,构建的CINV风险预测模型ROC曲线下面积(AUC)为0.843,敏感度为81.7%,特异性为73.3%,P<0.001;模型拟合优度检验Hosmer-Lemeshow检验的χ2=8.652,P=0.372。结论:CINV风险预测模型具有较好的区分度、精准度,模型性能良好,可引导医务人员为化疗患者制定个性化、科学合理的止吐方案提供依据。

Objective:To develop a risk prediction model of Chemotherapy-Induced Nausea and Vomiting(CINV),thus to provide a basis for the development of the best antiemetic regimen.Methods:High-risk factors of CINV were screened based on systematic literature review.Chemotherapy patients were investigated in the oncology department of 12 tertiary grade A hospitals in Chongqing from September 2020 to May 2021.The Chinese version of The Multinational Association of Supportive Care in Cancer(MASCC)Antiemetic Tool(MAT)was used to evaluate the occurrence of CINV.The vomiting that not occurrence or nausea NRS score<3 was treated as outcome indicators.The independent risk factors of CINV were analyzed by multi-factor Logistic regression,and the predictive efficacy,sensitivity and specificity of the CINV risk prediction model were evaluated by Receiver Operating Characteristic(ROC)curve analysis.Results:Among 2215 patients,639 patients(28.8%)developed vomiting or nausea with NRS score≥3.Multivariate Logistic regression analysis screened out 11 independent risk factors for CINV,the Area Under the ROC Curve(AUC)of the constructed CINV risk prediction model was 0.843,the sensitivity was 81.7%,the specificity was 73.3%(P<0.001).The Hosmer-Lemeshow test was used for model fit test withχ2=8.652,P=0.372.Conclusion:The Logistic regression-based CINV risk prediction model shows good discrimination,precision and model performance.It may provide a basis for medical personnel's development of personalized and reasonable antiemetic regimen for the patients.