A Nomogram-based Model to Predict Neoplastic Risk for Patients with Gallbladder Polyps

Background and Aims:Gallbladder polyp(GBP)assessment aims to identify the early stages of gallbladder carcinoma.Many studies have analyzed the risk factors for malignant GBPs.In this retrospective study,we aimed to establish a more accurate predictive model for potential neoplastic polyps in patients with GBPs.Methods:We devel-oped a nomogram-based model in a training cohort of 233 GBP patients.Clinical information,ultrasonographic find-ings,and blood test findings were analyzed.Mann-Whitney U test and multivariate logistic regression analyses were used to identify independent predictors and establish the nomogram model.An internal validation was conducted in 225 consecutive patients.Performance and clinical bene-fit of the model were evaluated using receiver operating characteristic curves and decision curve analysis(DCA),re-spectively.Results:Age,cholelithiasis,carcinoembryonic antigen,polyp size,and sessile shape were confirmed as independent predictors of GBP neoplastic potential in the training group.Compared with five other proposed predic-tion methods,the established nomogram model presented better discrimination of neoplastic GBPs in the training co-hort(area under the curve[AUC]:0.846)and the validation cohort(AUC:0.835).DCA demonstrated that the greatest clinical benefit was provided by the nomogram compared with the other five methods.Conclusions:Our developed preoperative nomogram model can successfully be used to evaluate the neoplastic potential of GBPs based on simple clinical variables that maybe useful for clinical decision-making.

临床Ⅰ期非小细胞肺癌诊断模型构建:基于临床影像学特征联合叶酸受体阳性循环肿瘤细胞检测的研究

目的分析叶酸受体阳性循环肿瘤细胞(folate receptor-positive circulating tumor cells,FR^(+)CTC)与患者肺部病灶良恶性的相关性,建立基于临床资料、影像学和FR^(+)CTC的肺部肿物恶性预测模型。方法回顾性分析青岛大学附属医院2018年9月至2019年12月1 277例行外周血循环肿瘤细胞检查且病理结果明确的肺结节及肺肿瘤患者的临床资料,其中男518例、女759例,中位年龄为57(29~85)岁。随机将患者分配到试验组和验证组,进行单因素及多因素分析,建立Nomogram预测模型,对其进行内部及外部验证,受试者工作特征(ROC)曲线检验模型区分度,校准曲线检验模型一致性。结果试验组非小细胞肺癌患者925例、良性疾病患者113例;验证组非小细胞肺癌患者219例、良性疾病患者20例,非小细胞肺癌患者外周血中FR^(+)CTC明显高于肺部良性疾病患者(P<0.001)。多因素分析显示年龄≥60岁、女性、FR^(+)CTC值>8.7 FU/3 m L、胸膜牵拉征阳性、结节直径、毛刺征阳性、结节中实性成分直径比值<1是病灶直径≤4 cm肺肿物良恶性病变的独立危险因素。建立Nomogram预测模型,区分度检验试验组ROC曲线下面积(AUC)值为0.918,敏感性为86.36%,特异性为83.19%;验证组AUC值为0.903,模型敏感性为79.45%,特异性为90.00%,表明Nomogram模型区分度良好。校准曲线表明Nomogram预测模型一致性良好。结论非小细胞肺癌患者外周血中FR^(+)CTC显著高于肺部良性疾病患者。本研究建立的临床Ⅰ期非小细胞肺癌诊断模型精准度良好,可以为临床诊断提供依据。