结直肠癌发生的影响因素及预测模型的建立

Influencing factors of colorectal cancer and the establishment of prediction model

目的分析结直肠癌发生的影响因素及建立预测模型。方法选取80例结直肠癌患者作为研究组,另选取40例同期住院的非恶性肿瘤患者作为对照组。分别收集两组患者一般资料、外周血中性粒细胞和淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、红细胞分布宽度(RDW)以及癌胚抗原(CEA)、糖类抗原199(CA199)结果,采用logistic回归分析结直肠癌发生的因素,构建Nomogram列线图,采用受试者工作特征(ROC)曲线和校准曲线评估Nomogram列线图的准确性。结果两组患者体重指数、文化程度、高脂饮食摄入、新鲜蔬菜摄入、情绪自我调节能力、阑尾炎病史、恶性肿瘤家族史比较,差异均有统计学意义(χ^(2)分别=2.72、4.27、5.19、8.12、5.76、4.81、5.28,P均<0.05)。研究组患者的NLR、PLR、RDW、CEA、CA199水平均高于对照组,差异均有统计学意义(t分别=25.09、27.22、11.05、27.78、65.05,P均<0.05)。logistic回归分析显示,高体重指数、高脂饮食摄入、新鲜蔬菜摄入不足、恶性肿瘤家族史、高RDW、高CA199是结直肠癌发生的独立危险因素(OR分别=1.32、1.36、1.34、1.42、1.46、1.49,P均<0.05)。Nomogram列线图预测发生结直肠癌的AUC为0.86(95%CI 0.79~0.94)。结论高体重指数、高脂饮食摄入、新鲜蔬菜摄入不足、恶性肿瘤家族史、高RDW、高CA199水平是结直肠癌发生的危险因素,构建的列线图风险预测模型经内部及外部验证效能良好。

Objective To analyze the risk factors of colorectal cancer and build a predictive model.Methods A total of 80 patients with colorectal cancer were selected as the study group,and 40 patients with non-malignant tumor who were hospitalized during the same period were selected as the control group.General data,peripheral blood neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),red blood cell distribution width(RDW),carcinoembryonic antigen(CEA)and carbohydrate antigen 199(CA199)results of the two groups were collected,and the factors of colorectal cancer occurrence were analyzed by logistic regression.Nomogram was constructed and the accuracy of the Nomogram was evaluated with receiver operating characteristic curve(ROC)and calibration curve.Results There were significant differences in body mass index(BMI),education level,intake of high-fat diet,intake of fresh vegetables,emotional self-regulation ability,history of appendicitis and family history of malignant tumor between the two groups(χ^(2)=2.72,4.27,5.19,8.12,5.76,4.81,5.28,P<0.05).The levels of NLR,PLR,RDW,CEA and CA199 in study group were higher than those in control group,and the differences were statistically significant(t=25.09,27.22,11.05,27.78,65.05,P<0.05).The logistic regression analysis showed that high BMI,high fat diet intake,insufficient intake of fresh vegetables,family history of malignant tumor,high RDW and CA199 were independent risk factors for colorectal cancer(OR=1.32,1.36,1.34,1.42,1.46,1.49,P<0.05).The AUC predicted by the nomogram was 0.86(95%CI 0.79-0.94).Conclusion High BMI,high fat diet intake,insufficient intake of fresh vegetables,family history of malignant tumors,high RDW and CA199 levels are risk factors for colorectal cancer.The constructed columniogram risk prediction model has been validated internally and externally.