即刻植入物乳房重建失败风险列线图模型的构建与验证

Development and validation of a nomogram to predict failure rate in immediate implant-based breast reconstruction

目的评估即刻植入物乳房重建(IBR)失败的风险因素,构建列线图模型并验证。方法回顾性分析2016年1月至2020年12月在浙江省肿瘤医院行即刻IBR手术的241例患者,按7∶3随机分为训练组(169例)和验证组(72例)。训练组依据重建失败(RF)是否发生,分为RF组(10例)和非RF组(159例),比较并分析两组临床资料,采用多因素logistic回归分析影响RF的独立风险因素,建立列线图模型;绘制ROC曲线,评估模型预测即刻IBR术后RF的效能;绘制校准曲线,评估即刻IBR术后发生RF的一致性。结果高BMI、植入物体积>86.30%、辅助化疗(ACT)是即刻IBR术后RF的独立风险因素(均P<0.05)。基于BMI、淋巴结手术方式、植入物体积、补片使用和ACT这5个变量构建列线图模型,模型预测训练组即刻IBR术后RF的AUC为0.920,预测验证组的AUC为0.930;模型的Brier评分为0.040。校准曲线显示,实际观察和模型预测之间存在较好的一致性。结论列线图模型能够较好预测即刻IBR术后RF的风险,有助于指导临床早期干预RF。

Objective To evaluate the risk factors for immediate implant-based breast reconstruction(IBR)failure,and to construct a nomogram model and validate it.Methods A total of 241 patients who underwent immediate IBR surgery in Zhejiang Cancer Hospital from January 2016 to December 2020 were retrospectively analyzed and randomly divided into a training cohort(169 cases)and a validation cohort(72 cases)by 7∶3.The training cohort was divided into reconstruction failure(RF)group(10 cases)and non-RF group(159 cases)based on whether RF occurred.Clinical data that might affect RF in immediate IBR surgery were collected.Multivariate logistic regression was used to analyze independent risk factors affecting RF to establish a nomogram and the ROC curves were drawn to evaluate the efficiency of the model prediction.Calibration curves were also drawn to assess the consistency of RF after immediate IBR surgery.Results Multivariate logistic regression analysis showed that high BMI,implant volume>86.30%,and adjuvant chemotherapy(ACT)were independent risk factors for RF in immediate IBR surgery(all P<0.05).A nomogram model was constructed based on five variables:BMI,lymph node surgery type,implant volume,mesh application and ACT.The AUC of the model in predicting the RF of immediate IBR surgery was 0.920 in training cohort and was 0.930 in validation cohort,the Brier score was 0.040 respectively.The calibration curve showed good consistency between the actual observation and the model prediction.Conclusion The nomogram established shows good performance in predicting the risk of RF in immediate IBR surgery and is easy to use,which can guide the early intervention of RF.