肺癌术后化疗期间症状群困扰风险影响因素分析及列线图模型构建

Construction of a nomogram model for the status quo of symptom groups and their risk of distress during postoperative chemotherapy for lung cancer

目的调查肺癌术后化疗期间症状群现状,分析影响肺癌术后化疗期间症状群困扰风险的影响因素,并构建肺癌化疗症状群困扰风险预测模型。方法收集2018年6月-2022年8月于首都医科大学附属北京友谊医院进行术后化疗的190例肺癌患者的临床资料,根据中文版安德森症状测评量表(MDASI-C)评估化疗症状群困扰程度将其分为轻度困扰组及重度困扰组,并对两组临床资料进行比较。采用单因素分析和多因素Logistic回归分析肺癌术后化疗期间存在症状群重度困扰的危险因素,构建风险预测模型,并对模型进行内、外部验证。结果190例肺癌患者术后化疗期间有180例(94.74%)发生不同程度的疲乏,134例(70.53%)发生不同程度的焦虑,97例(51.05%)发生不同程度的疼痛,124例(65.26%)发生不同程度的睡眠障碍;Logistic回归模型分析结果显示,TNM分期Ⅲ期、化疗周期≥4个、Ⅲ~Ⅳ级不良反应、白细胞计数<2×10^(9)/L、血小板计数<100×10^(9)/L是肺癌术后患者对化疗期间症状群存在重度困扰的独立危险因素(P<0.05);根据Logistic回归分析结果构建风险预测模型列线图,内部及外部验证结果显示,曲线下面积(AUC)分别为0.832、0.867,95%CI分别为(0.771~0.882)、(0.779~0.929),校准曲线与实际曲线接近重合,Hosmer-Lemeshow拟合优度检验χ^(2)=1.896,P=0.204。结论肺癌术后化疗期间疲乏-负性情绪-疼痛-睡眠障碍症状群发生率较高,基于其危险因素构建的风险预测模型对肺癌术后化疗期间发生症状群的及困扰程度具有良好的预测价值,有利于肺癌术后化疗期间发生症状群的早期筛查。

Objective:To investigate the status of symptom groups during postoperative chemotherapy for lung cancer,andto analyze the factors influencing the risk of symptom group disturbance during postoperative chemotherapy for lung cancer,and toconstruct a prediction model of symptom group disturbance risk during chemotherapy for lung cancer.Methods:A total of 190 patients with lung cancer who underwent postoperative chemotherapy in Beijing Friendship Hospital from June 2018 to August 2022 were selected to collect clinical data.The Chinese version of Anderson Symptom Assessment Scale was used to evaluate the distress degree of chemotherapy symptom groups,which were divided into mild distress group and severe distress group,and the clinical data of the 2 groups were compared.Univariate analysis and multivariate Logistic regression were used to analyze the risk factors of severe disturbance of symptom groups during chemotherapy after lung cancer surgery,and the risk prediction model was constructed,and the model was verified internally and externally.Results:In 190 patients with lung cancer,180 cases(94.74%)had different degrees of fatigue,134 cases(70.53%)had different degrees of anxiety,97 cases(51.05%)had different degrees of pain,and 124 cases(65.26%)had different degrees of sleep disorders during postoperative chemotherapy.Logistic regression model analysis showed that TNM stageⅢ,chemotherapy cycle≥4,gradeⅢ~Ⅳadverse reactions,white blood cell count<2×10^(9)/L,platelet<100×10^(9)/L were independent risk factors for severe disturbance of symptoms during chemotherapy in patients with lung cancer after surgery(P<0.05).According to the Logistic regression analysis results,the risk prediction model was constructed.Internal and external verification results showed that the area under the curve was 0.832,0.867 and 95%CI was(0.771~0.882)and(0.779~0.929),respectively.The calibration curve was close to the actual curve,Hosmer-lemeshow goodness of fit testχ^(2)=1.896,P=0.204.Conclusion:The incidence of fatigue-negative emotion-pain-sleep disorder during chemotherapy after lung cancer surgery was higher.The risk prediction model built based on its risk factors has a good predictive value for the occurrence of symptom groups and the degree of distress during lung cancer chemotherapy,which is conducive to the early screening of symptom groups during lung cancer chemotherapy.