基于乳酸脱氢酶建立上皮性卵巢癌铂耐药复发预测模型

Development of a lactate dehydrogenase-based nomogram to predict platinum-resistant recurrence of epithelial ovarian cancer

目的构建预测上皮性卵巢癌(epithelial ovarian cancer,EOC)铂耐药复发的风险模型。方法回顾性分析2012年1月1日至2022年6月30日在云南省肿瘤医院行手术治疗的1392例EOC患者的临床病理资料。对可能影响铂耐药复发的16个因素进行单因素和多因素logistic回归分析并构建logistic回归预测模型。采用加强Bootstrap法对模型进行内部验证。模型表现通过受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)、敏感度、特异度和Brier得分评价,并将模型可视化为列线图和网页计算器。结果多因素logistic回归分析显示,血清乳酸脱氢酶水平、国际妇产科联合会(International Federation of Gynecology and Obstetrics,FIGO)分期、术后化疗周期和血小板计数均是影响EOC铂耐药复发的独立影响因素(均P<0.05)。基于年龄和上述变量构建的logistic回归模型的AUC、敏感度和特异度分别为0.704、62.0%和68.4%。模型在内部验证中的Brier得分为0.002。结论基于乳酸脱氢酶开发的预测EOC患者铂耐药复发的列线图可用于指导临床实践。

Objective To develop a risk model to predict the platinum-resistant recurrence of epithelial ovarian cancer(EOC).Methods The clinicopathological data of 1392 EOC patients who underwent surgical treatment at Yunnan Cancer Hospital from January 1st,2012,to June 30th,2022,were retrospectively analyzed.Univariate and multivariate logistic regression was used to analyze 16 variables related to platinum-resistant recurrence,and a logistic regression prediction model was constructed.Bootstrap method was used to validate the model internally.The performance of the model was evaluated by the area under the receiver operating characteristic(ROC)curve(AUC),sensitivity,specificity and Brier score.The model was presented as a nomogram and a web calculator.Results Multivariate logistic regres-sion showed that serum lactate dehydrogenase level,the International Federation of Obstetrics and Gynecology(FIGO)stage,the number of postoperative chemotherapy cycles,and platelet count were independent risk factors for the platinum-resistant recurrence of EOC(all P<0.05).Based on age and the above variables,a logistic regression model was constructed,with an AUC of 0.704,a sensitivity of 62.0%and a specificity of 68.4%.The Brier score in internal validation was 0.002.Conclusions Based on serum lactate dehydrogenase level,a nomogram predicting the platinum-resistant recurrence of EOC patients was successfully developed which is useful in clinical practice.