基于Logistic回归和Nomogram模型构建对非小细胞肺癌术后转移的预测价值

Predicting postoperative metastasis of non-small cell lung cancer based on logistic regression and currently constructed nomogram models

目的:探讨非小细胞肺癌术后转移的危险因素,并构建非小细胞肺癌术后转移的列线图模型。方法:选取2018年5月~2021年2月在南京市胸科医院进行手术治疗的265例非小细胞肺癌患者作为模型组,将2021年3月~2022年6月在我院进行手术治疗的96例非小细胞肺癌患者作为验证组。应用Lasso分析筛选非小细胞肺癌术后转移的预测因素,应用Logistic回归分析筛选非小细胞肺癌术后转移的危险因素,应用R(4.2.0)软件构建非小细胞肺癌术后转移的列线图模型,并对非小细胞肺癌术后转移的列线图模型进行验证。结果:Logistic回归分析结果显示,肿瘤最大径>3cm、分化程度、临床分期、癌胚抗原(CEA)、D-二聚体及MGMT基因启动子甲基化等是非小细胞肺癌术后转移的危险因素(P<0.05)。校正曲线显示模型组和验证组的预测值和实际值的拟合度皆较好;模型组和验证组的AUC分别为0.732和0.843。模型组的决策曲线显示非小细胞肺癌术后转移列线图模型的临床效用较好。结论:肿瘤最大径、分化程度、临床分期、CEA、D-二聚体及MGMT基因启动子甲基化等是非小细胞肺癌术后转移的影响因素,非小细胞肺癌术后转移的列线图模型有利于临床对非小细胞肺癌术后转移进行防治。

Objective:To investigate the risk factors for postoperative metastasis of non-small cell lung cancer(NSCLC),and construct a nomogram model for predicting postoperative metastasis of this tumor.Methods:265 NSCLC patients surgically treated in our hospital between May 2018 and February 2021 were included in the model group,and another 96 NSCLC patients undergone surgical treatment in our hospital between March 2021 and June 2022 were recruited in validation group.LASSO analysis was performed,and logistic regression model was used to respectively screen the predictive factors and risk factors for postoperative metastasis of NSCLC.Nomograph model for postoperative metastasis of NSCLC was constructed using software R(version:4.2.0),and validated as well.Results:Logistic regression analysis showed that the risk factors for postoperative metastasis of NSCLC were associated with maximum tumor diameter>3cm,differentiation degree,clinical stage,level of carcinoembryonic antigen(CEA),D-dimer and MGMT gene promoter methylation(all P<0.05).The calibration curve demonstrated better fit between the predicted and actual values in both groups.The AUC was 0.732 and 0.843,respectively for the model group and the validation group.The decision curve of the model group showed that currently constructed nomogram model had better clinical efficacy for estimation of postoperative metastasis of NSCLC.Conclusion:Tumor maximum diameter,differentiation degree,clinical stage,CEA level,D-dimer and MGMT gene promoter methylation are influencing factors for postoperative metastasis of NSCLC.The nomogram model constructed in current study can be clinically conductive to early prevention and treatment of postoperative metastasis of this neoplasm.