摘要
目的用Lasso-Cox回归建立直肠癌预后模型并进行验证。方法分析599例行直肠癌根治术患者的临床、病理数据;t检验、曼惠特尼检验、卡方检验进行组间比较;Lasso和Cox回归筛选变量,建立模型;受试者工作特征曲线(ROC)、校准曲线和决策曲线分析(DCA)评估模型的区分度、一致性和临床获益。结果组间比较发现:年龄、身体质量指数(BMI)、术前营养评分、CA199、新辅助治疗、术中输血、血管神经侵犯、癌结节、T分期、N分期、TNM分期、复发转移、放疗、生存时间与术后死亡有关(均P<0.05);Lasso回归筛选出的8个变量纳入Cox回归,年龄(HR=1.04,P<0.05)、BMI(HR=0.89,P<0.05)、输血(HR=2.29,P<0.05)、术后化疗(HR=0.16,P<0.01)、复发(HR=43.67,P<0.01)、转移(HR=2.75,P<0.05)被确定为影响直肠癌预后的独立因素;预测模型的ROC曲线下面积为0.95(95%CI:0.91~0.99),P<0.01;1年、3年生存的预测概率和实际概率接近;DCA曲线远离平行于X轴的决策线和另一条斜率为负数的线。结论该研究构建的列线图具有较好的区分度、一致性和临床获益,有助于预测直肠癌的预后情况。
Objective To construct and appraise a new model for predicting the prognosis of rectal cancer patients using the Lasso-Cox strategy.Methods The clinical pathological data of 599 rectal cancer patients who underwent radical resection were analyzed.Comparison between groups,Lasso and Cox regression were used to select variables and construct a model,and its discrimination,consistency,and clinical benefits were appraised by the receiver operating characteristic(ROC),calibration curve,and decision curve analysis.Results Comparison between groups showed that age,body mass index(BMI),preoperational nutrition status,carbohydrate antigen199(CA199),preoperative chemotherapy,intraoperative blood transfusion,vascular or nerve invasion,cancer nodules,pathologic T,N,and TNM stages,tumor recurrence or metastasis,radiotherapy and postoperative survival time were associated with grouping of death or survival in rectal cancer patients.Among them,8 variables were selected by lasso and contained into the Cox regression model.Age(HR=1.04,P<0.05),BMI(HR=0.89,P<0.05),blood transfusion(HR=2.29,P<0.05),postoperative chemotherapy(HR=0.16,P<0.01),recurrence(HR=43.67,P<0.01),and metastasis(HR=2.75,P<0.05)were identified as independent prognostic factors,which were used to construct a nomogram model.The area under the curve(AUC)and the 95%confidence interval of the receiver operating characteristic(ROC)curve of the predictive model was 0.95(0.91-0.99),P<0.01.The predicted probability of 1-year and 3-year survival was close to the actual probability.The DCA curve of the model was far away from a decision line parallel to the X-axis and another line with a negative slope.Conclusion The newly established nomogram has good discrimination,consistency and clinical benefits,which help predict the prognosis of rectal cancer after surgery.
作者
李德关
汪圣毅
刘虎
张震
李永翔
Li Deguan;Wang Shengyi;Liu Hu;Zhang Zhen;Li Yongxiang(Dept of General Gastrointestinal Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Dept of Oncology,West District of the First Affiliated Hospital of University of Science and Technology of China,Anhui Provincial Cancer Hospital,Hefei 230031)
出处
《安徽医科大学学报》
CAS
北大核心
2023年第12期2129-2134,2138,共7页
Acta Universitatis Medicinalis Anhui
基金
国家自然科学基金(编号:82172974)。