胆囊癌患者术后无病生存期预测的列线图建立和验证

Establishment and verification of a nomogram for predicting postoperative disease-free survival in patients with gallbladder cancer

目的利用列线图建立胆囊癌患者术后无病生存期预测模型。方法采用回顾性分析方法,收集2018年1月一2023年1月就诊的浙江大学医学院附属第一医院205例胆囊癌患者作为建模组,浙江省肿瘤医院55例作为验证组。利用Cox单因素分析和多因素分析,确定独立影响因素;利用R语言,以各个独立因素为基础建立列线图,利用一致性指数(C-index)、校准曲线评价模型的精度。采用决策曲线(DCA)与AJCC第八版TNM分期系统进行比较,来评价模型的性能。结果多因素分析显示,T分期、N分期、分化程度(Grade)、纤维蛋白原/白蛋白(FAR)和糖类抗原19-9(CA19-9)是影响患者无病生存期的独立危险因素(P<0.05)。列线图验证,内部验证C指数为0.780,外部验证C指数为0.717;校准曲线显示,在预测1年和3年无病生存期概率上与实际观察结果有很好的一致性;决策曲线(DCA)显示,本模型相较于AJCC第八版TNM分期系统具有更好的临床预测能力。结论本研究建立可以预测胆囊癌患者无病生存期的列线图,且更直观、准确,有助于临床决策。

Objective This paper aims to establish a prediction model for postoperative disease-free survival of patients with gallbladder cancer by nomogram.Methods Retrospective analysis was used to collect 205 patients with gallbladder cancer from the First Affiliated Hospital of Zhejiang University Medical School from January 2018 to January 2023 as the modeling group,and 55 patients from Zhejiang Cancer Hospital were selected as the validation group.Independent influencing factors were deter-mined by Cox univariate analysis and multivariate analysis.R language was used to establish a nomogram based on each inde-pendent factor,and C-index and calibration curve were used to evaluate the accuracy of the model.The performance of the model was evaluated by comparing the decision curve(DCA)with the AJCC g"TNM staging system.Results Multivariate analysis showed that T stage,N stage,differentiation degree(Grade),fibrinogen/albumin(FAR)and carbohydrate antigen 19-9(CA19-9)were independent risk factors for disease-free survival(P<0.05).Verification of nomogram show that in-ternal verification C index was 0.780,and external verification C index was 0.717.The calibration curve showed a good agree-ment with the actual observation results in predicting the probability of 1-year and 3-year disease-free survival.Decision making curves(DCA)showed that this model had beter clinical predictive power than the AJCC 8th TNM staging system.Con-clusion In this study,a more intuitive and accurate model was established to predict the disease-free survival of gallbladder cancer patients,which is helpful for clinical decision-making.