老年肺癌患者化疗期间发生营养不良的影响因素分析及其风险预测列线图模型构建

Influencing Factors of Malnutrition in Elderly Patients with Lung Cancer during Chemotherapy and Its Risk Prediction Nomogram Model

目的探讨老年肺癌患者化疗期间发生营养不良的影响因素,并构建其风险预测列线图模型。方法选取2022年6月—2023年12月南宁市第二人民医院肿瘤科和广西医科大学附属肿瘤医院呼吸肿瘤内科收治的491例老年肺癌患者为研究对象,按照7∶3的比例采用随机分配原则将患者分为训练集(n=344)和验证集(n=147),然后根据营养不良发生情况将训练集患者分为营养正常组[营养风险筛查2002(NRS 2002)量表总评分<3分,n=137]和营养不良组(NRS 2002量表总评分≥3分,n=207)。查阅相关文献并制定临床资料调查表,所有患者化疗周期结束后1周内采用面对面方式填写临床资料调查表。老年肺癌患者化疗期间发生营养不良的影响因素分析采用Lasso回归、多因素Logistic回归分析,根据多因素Logistic回归分析结果构建老年肺癌患者化疗期间发生营养不良的风险预测列线图模型,绘制ROC曲线以评估该列线图模型对老年肺癌患者化疗期间发生营养不良的预测价值,绘制校准曲线以评估该列线图模型的拟合程度。结果两组BMI、有基础疾病者占比、化疗次数、卡氏评分、疼痛程度、恶心呕吐发生率、腹泻发生率、食欲减退发生率、便秘发生率、总蛋白、白蛋白、前白蛋白、血红蛋白、抑郁自评量表(SDS)评分比较,差异有统计学意义(P<0.05)。Lasso回归分析结果显示,BMI、化疗次数、卡氏评分、恶心呕吐、食欲减退、白蛋白、前白蛋白、血红蛋白、SDS评分可能是老年肺癌患者化疗期间发生营养不良的影响因素。多因素Logistic回归分析结果显示,BMI、化疗次数、卡氏评分、恶心呕吐、食欲减退、白蛋白、前白蛋白、血红蛋白、SDS评分是老年肺癌患者化疗期间发生营养不良的独立影响因素(P<0.05)。基于多因素Logistic回归分析结果构建老年肺癌患者化疗期间发生营养不良的风险预测列线图模型。ROC曲线分析结果显示,该列线图模型预测验证集老年肺癌患者化疗期间发生营养不良的AUC为0.965[95%CI(0.946~0.984)]。校准曲线分析结果显示,该列线图模型的拟合程度较好。结论BMI、化疗次数、卡氏评分、恶心呕吐、食欲减退、白蛋白、前白蛋白、血红蛋白、SDS评分是老年肺癌患者化疗期间发生营养不良的独立影响因素,而基于上述影响因素构建的列线图模型对老年肺癌患者化疗期间发生营养不良的预测价值较高。

Objective To explore the influencing factors of malnutrition in elderly patients with lung cancer during chemotherapy,and to construct its risk prediction nomogram model.Methods A total of 491 elderly patients with lung cancer admitted to the Department of Oncology of the Second Nanning People's Hospital and the Department of Respiratory Oncology Medicine of Guangxi Medical University Cancer Hospital from June 2022 to December 2023 were selected as the research objects.According to the principle of in a 7∶3 ratio random distribution,the patients were divided into training set(n=344)and validation set(n=147).Then,according to whether malnutrition occurred,the patients in the training set were divided into normal nutrition group[total score of Nutritional Risk Screening 2002(NRS 2002)Scale<3,n=137]and malnutrition group(total score of NRS 2002 Scale≥3,n=207).The relevant literature was reviewed and the clinical data questionnaire was developed.All patients filled in the clinical data questionnaire face-to-face within 1 week after the end of the chemotherapy cycle.The influencing factors of malnutrition in elderly patients with lung cancer during chemotherapy were analyzed by Lasso regression analysis and multivariate Logistic regression analysis.According to the results of multivariate Logistic regression analysis,the nomogram model for predicting the risk of malnutrition in elderly patients with lung cancer during chemotherapy was constructed,and the ROC curve was drawn to evaluate the predictive value of the nomogram model for malnutrition in elderly patients with lung cancer during chemotherapy.The calibration curve was drawn to evaluate the fitting degree of the nomogram model.Results There were statistically significant differences in BMI,proportion of patients with underlying diseases,number of chemotherapy,Karnofsky score,degree of pain,incidence of nausea and vomiting,incidence of diarrhea,incidence of anorexia,incidence of constipation,total protein,albumin,prealbumin,hemoglobin and Self Rating Depression Scale(SDS)score between the two groups(P<0.05).The results of Lasso regression analysis showed that BMI,number of chemotherapy,Karnofsky score,nausea and vomiting,anorexia,albumin,prealbumin,hemoglobin and SDS score may be the influencing factors of malnutrition in elderly patients with lung cancer during chemotherapy.Multivariate Logistic regression analysis showed that BMI,number of chemotherapy,Karnofsky score,nausea and vomiting,anorexia,albumin,prealbumin,hemoglobin and SDS score were independent influencing factors of malnutrition in elderly patients with lung cancer during chemotherapy(P<0.05).Based on the results of multivariate Logistic regression analysis,the nomogram model for predicting the risk of malnutrition in elderly patients with lung cancer during chemotherapy was constructed.ROC curve analysis showed that the AUC of the nomogram model for predicting malnutrition in elderly patients with lung cancer during chemotherapy in the validation set was 0.965[95%CI(0.946-0.984)].The results of calibration curve analysis showed that the nomogram model had a good fitting degree.Conclusion BMI,number of chemotherapy,Karnofsky score,nausea and vomiting,anorexia,albumin,prealbumin,hemoglobin and SDS score were independent influencing factors of malnutrition in elderly patients with lung cancer during chemotherapy.The nomogram model construced based on the above influencing factors had a higher predictive value for malnutrition in elderly patients with lung cancer during chemotherapy.