胆囊鳞癌及腺鳞癌临床病理特征分析及预后预测模型构建

A Nomogram for prediction of overall survival for patients with gallbladder squamous and adenosquamous carcinoma

目的分析胆囊鳞癌和腺鳞癌的预后影响因素并构建预后预测模型。方法回顾性分析2012年1月至2021年12月东方肝胆外科医院行外科手术切除的114例胆囊鳞癌及腺鳞癌患者的临床资料。通过单因素和多因素Cox回归分析确定胆囊鳞癌和腺鳞癌的预后影响因素,并构建列线图(Nomogram)预测模型。应用C-指数、ROC曲线以及校准曲线对模型进行评估。结果单因素分析结果提示,T分期、TNM分期、切缘性质、血管侵犯、联合肝切除、淋巴结清扫是胆囊鳞癌和腺鳞癌患者术后生存的影响因素。多因素Cox回归分析提示,只有T分期、联合肝切除是鳞癌和腺鳞癌患者术后生存的重要影响因素,此时赤池信息测量准则(AIC)值最小(720.66),并据此建立胆囊鳞癌和腺鳞癌Nomogram预测模型。该模型C-指数为0.614(95%Ci 0.585~0.643)。1年、2年、3年ROC曲线下面积分别为0.605、0.598、0.592。校准曲线图可见实际观测值与预测值具有较好的一致性。结论T分期、联合肝切除是胆囊鳞癌和腺鳞癌患者术后生存的重要影响因素,据此建立的Nomogram具有一定的区分度和准确度,有一定的临床参考价值。

objective To develop a Nomogram to predict the overall survival(OS)of patients with gallbladder squamous or adenosquamous carcinoma.Methods The clinical data of 114 patients with gallbladder squamous or adenosquamous carcinoma who underwent surgical resection in Eastern Hepatobiliary Surgery Hospital between Jan.2012 and Dec.2021 were retrospectively analyzed.Univariate and multivariate Cox analyses were used to explore the independent prognostic factors and to establish a Nomogram.The C-index,ROC curve,and calibration curves were used to evaluate the Nomogram.Results Univariate Cox analysis showed that,T classification,TNM stage,resection margin,vascular invasion,combined hepatectomy,and lymphadenectomy were prognostic factors associated with OS.T classification and combined hepatectomy were two important prognostic variables furtherly confirmed by multivariate Cox analysis.A Nomogram was constructed successfully based on the T classification and combined hepatectomy and the Akaike information critertion(AIC)value was the lowest(720.66).The C-index of the Nomogram was 0.614(95%Ci 0.585-0.643).The AUCs were 0.605,0.598,and 0.592 for predicting 1-,2-,and 3-year OS,respectively.The calibration curve revealed that the Nomogram had a good ability to predict OS.Conclusion T classification and hepatectomy are confirmed as critital prognostic variables for OS.The Nomogram based on T classification and combined hepatectomy provides certain discrimination and accuracy.