临床特征及术前检验结果在低级别软骨肉瘤和内生软骨瘤鉴别中的作用

Clinical Features and Preoperative Laboratory Results in the Differential Diagnosis of Low-grade Chondrosarcoma and Enchondroma

目的分析低级别软骨肉瘤和内生软骨瘤患者的临床特征及术前各项检查指标的结果,及其在两者鉴别中的作用。方法收集2015年1月至2020年12月在华中科技大学同济医学院附属同济医院行手术治疗的105例内生软骨瘤和42例低级别软骨肉瘤患者的临床资料。通过Spearman相关性检验和ROC曲线分析术前的临床及检查指标与术后肿瘤性质的相关性,并分析其鉴别诊断能力,多因素Logistic回归分析明确与肿瘤性质相关的危险因素并构建Nomogram预测模型。结果低级别软骨肉瘤组的患者年龄、肿瘤大小、中性粒与淋巴细胞比值(NLR)及碱性磷酸酶(ALP)明显高于内生软骨瘤组,而淋巴细胞与单核细胞比值(LMR)及白蛋白与球蛋白比值(AGR)则明显更低。肿瘤大小和NLR值与低级别软骨肉瘤的诊断呈正相关,而LMR值与其呈负相关;这3个因素与肿瘤性质间的Spearman相关系数的绝对值均大于0.4且AUC值均大于0.7。肿瘤大小、NLR及LMR值鉴别两种肿瘤的最佳截断值分别为6.3 cm、1.6和4.3。Nomogram模型对于鉴别内生软骨瘤和低级别软骨肉瘤有较好的效能,该模型的ROC曲线下面积为0.96。结论对于诊断不明确的软骨源性肿瘤,患者的临床特征及术前检查指标可能有助于低级别软骨肉瘤和内生软骨瘤的鉴别。

Objective To analyze the clinical features and preoperative laboratory results of patients with low.grade chondrosarcoma(CS)and enchondroma,and to explore whether these indicators can help to differentiate the two diseases.Methods Clinical data was collected from 105 patients with enchondroma and 42 patients with low grade CS who underwent surgery in Tongji Hospital from January 2015 to December 2020,and the Spearman correlation test and receiver operating characteristic(ROC)curve analysis were used to clarify the correlation between clinical features and preoperative blood test indicators and postoperative tumor malignancy,and to measure their efficacy in differential diagnosis.Multivariate logistic regression analysis was used to identify the risk factors associated with tumor malignancy,and Nomogram model was constructed.Results Age,tumor size,NLR and ALP ratios were significantly higher in low grade CS group than that in enchondroma group,while LMR and AGR ratios were significantly lower.Tumor size and NLR ratio were positively correlated with low-grade CS,while LMR ratio was negatively correlated.The absolute values of Spearman correlation coefficients of these three factors were all greater than 0.4 and the AUC values were all greater than 0.7.The optimal cut-off values for tumor size,NLR and LMR to differentiate the two tumors were 6.3 cm,1.6,and 4.3,respectively.The Nomogram model was effective in differentiating enchondroma from low-grade CS,and the area under ROC curve was 0.96.Conclusion For cartilaginous tumors with unclear diagnosis,clinical features and preoperative blood test indicators may help in the differential diagnosis between low grade CS and enchondroma.