卵巢肿瘤术前恶性风险诊断模型的构建与验证

Construction and verification of preoperative malignant risk diagnostic model for ovarian tumors

目的构建并验证卵巢肿瘤术前恶性风险的诊断模型,以提高现有检验指标的诊断效能。方法回顾性收集在2019年1月—2023年9月就诊于西南医科大学附属医院接受手术治疗且经病理证实为卵巢肿瘤患者的相关血清学指标和临床资料,将患者按7∶3的比例随机划分为训练集及验证集,在训练集中利用logistic回归先单因素分析再逐步回归构建诊断模型,通过区分度、校准度、临床获益及临床适用性评价验证模型诊断效能。结果共纳入卵巢肿瘤患者929例,其中卵巢恶性肿瘤318例,卵巢良性肿瘤611例;随机划分为训练集658例,验证集271例。在训练集中通过logistic回归构建诊断模型,最终的诊断模型包括年龄、中性粒细胞百分比、纤维蛋白原与白蛋白比值(fibrinogen to albumin ratio,FAR)、糖类抗原125(carbohydrate antigen 125,CA125)、人附睾蛋白4(human epididymis protein 4,HE4)共5个变量:modelUAM=-3.211+0.667×年龄+2.966×CA125+0.792×FAR+1.637×HE4+0.533×中性粒细胞百分比,Hosmer-Lemeshow检验P值为0.21。训练集中测得受试者操作特征曲线下面积为0.927[95%置信区间(0.903,0.951)],灵敏度为0.947,特异度为0.780;验证集的受试者操作特征曲线下面积为0.888[95%置信区间(0.840,0.930)],灵敏度为0.744,特异度为0.901。结论利用年龄、中性粒细胞百分比、FAR、CA125和HE4构建的新型量化工具可作为临床诊断卵巢恶性肿瘤的参考依据,有助于提高诊断效能,值得推广应用。

Objective To construct and verify the diagnostic model of preoperative malignant risk of ovarian tumors,so as to improve the diagnostic efficiency of existing test indexes.Methods The related serological indicators and clinical data of patients with ovarian tumors confirmed by pathology who were treated in the Affiliated Hospital of Southwest Medical University between January 2019 and September 2023 were retrospectively collected,and the patients were randomly divided into a training set and a verification set at a 7∶3 ratio.Logistic regression was used to construct a diagnostic model in the training set,and the diagnostic efficacy of the model was verified through discrimination,calibration,clinical benefit,and clinical applicability evaluation.Results A total of 929 patients with ovarian tumors were included,including 318 cases of malignant ovarian tumors and 611 cases of benign ovarian tumors.The patients were randomly divided into a training set of 658 cases and a validation set of 271 cases.A diagnostic model was constructed using logistic regression in the training set,containing 5 factors namely age,percentage of neutrophil(NEU%),fibrinogen to albumin ratio(FAR),carbohydrate antigen 125(CA125),and human epididymis protein 4(HE4):modelUAM=−3.211+0.667×age+2.966×CA125+0.792×FAR+1.637×HE4+0.533×NEU%,with a Hosmer-Lemeshow test Pvalue of 0.21.The area under the receiver operating characteristic(ROC)curve measured in the training set was 0.927[95%confidence interval(0.903,0.951)],the sensitivity was 0.947,and the specificity was 0.780.The area under the ROC curve of the validation set was 0.888[95%confidence interval(0.840,0.930)],the sensitivity was 0.744,and the specificity was 0.901.Conclusion A new quantitative tool based on age,NEU%,FAR,CA125 and HE4 can be used for the clinical diagnosis of ovarian malignant tumors,and it is helpful to improve the diagnostic efficiency and is worth popularizing.