ⅠA2～ⅡA2期子宫颈癌术后复发风险预测评分表的建立

Establishment of the Risk Prediction Scale of Postoperative Recurrence of Cervical Cancer in ⅠA2-ⅡA2 Stage

目的:分析ⅠA2~ⅡA2期子宫颈癌患者术后复发的影响因素,建立一个综合、简易、有效的复发风险预测评分表以评估患者术后复发风险。方法:回顾性纳入郑州大学第一附属医院2013年1月至2016年1月行子宫颈癌根治术的ⅠA2~ⅡA2期患者1193例作为建模队列。2016年2~6月收治患者287例作为验证队列。采用多因素Logistic回归分析术后复发的影响因素,根据分析结果建立复发风险预测评分表。根据所建模型受试者工作特征(ROC)曲线最佳界值(cut-off值)及评分大小将评分表分为低危、中危、高危。在验证队列中应用所建评分表,评判其可重复性。结果:①多因素Logistic回归分析示:肿瘤直径≥4 cm(OR 3.061,95%CI 1.123~8.347),浸润深度≥1/2(OR 2.565,95%CI 1.233~5.333),淋巴结转移(OR 2.919,95%CI 1.610~5.294),除鳞癌、腺癌的其他组织学类型(OR 3.297,95%CI 1.023~10.634),是影响复发的独立危险因素(P<0.05)。②纳入以上4个独立危险因素入子宫颈癌复发风险预测评分表,该评分表有较高的预测价值(AUC=0.749,95%CI 0.687~0.811),拟合优度一致性较高(χ~2=0.386,P>0.05)。评分表分层情况为低危(0~16分)、中危(16~31分)、高危(31~43分),经χ~2检验三层之间复发率差异有统计学意义(χ~2=72.610,P<0.05)。③经验证评分表与建模队列ROC曲线的AUC相比,差异无统计学意义(Z=-0.016,P>0.05),其拟合优度一致性较高(χ~2=3.038,P>0.05),具有一定可重复性。结论:该研究构建的简易评分表可较准确预测ⅠA2~ⅡA2期子宫颈癌患者术后的复发风险,但仍需多中心大样本研究进一步完善与验证。

Objective:To analyze postoperative risk factors ofⅠA2-ⅡA2 stage cervical cancer,and establish a comprehensive,simple and effective postoperative recurrence risk prediction scale.Methods:A retrospective study of 1193 patients withⅠA2-ⅡA2 stage who underwent radical cervical cancer resection in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2016 was performed as the model cohort.From February 2016 to June 2016,287 patients were admitted as the validation cohort.Multivariate Logistic regression wasused to analyze the factors influencing postoperative recurrence,and a recurrence risk prediction scale was established according to the analysis results.According to the optimal cut-off value and score size of the ROC curve of the model,the rating scale was divided into three layers:low risk,medium risk and high risk.The reproducibility of the proposed scale was evaluated in the validation queue.Results:①Multivariate Logistic regression analysis showed that tumor size≥4 cm(OR 3.061,95%CI 1.123-8.347),infiltration depth≥1/2(OR 2.565,95%CI 1.233-5.333),lymph node metastasis(OR 2.919,95%CI 1.610-5.294),and other tissue types(OR 3.297,95%CI 1.023-10.634)were independent risk factors for recurrence(P<0.05).②The above four independent risk factors were included in the risk prediction scale of cervical cancer recurrence.The scale had high predictive value(AUC=0.749,95%CI 0.687~0.811)and high consistency of goodness of fit(χ~2=0.386,P>0.05).The grading of the scale was low risk(0-16),medium risk(16-31)and high risk(31-43).There was significant difference in recurrence rate among the three layers byχ~2 test(χ~2=72.610,P<0.05).③There was no significant difference between the verified score table and the AUC of the ROC curve of the modeling queue(Z=-0.016,P>0.05).The consistency of goodness of fit was high(χ~2=3.038,P>0.05),and it had certain reproducibility.Conclusions:The simple rating scale constructed in this study can accurately predict the risk of postoperative recurrence in patients with stageⅠA2-Ⅱ2 cervical cancer,but multi-center large sample study is still needed to further improve and verify this scale.