摘要
目的构建基于控制营养状况(CONUT)评分的临床预测模型,并验证其预测晚期胰腺癌患者预后的价值。方法回顾性分析自2010年1月至2018年12月于中国医科大学肿瘤医院肝胆胰外科确诊并治疗的306例晚期胰腺癌患者的临床资料。随机将患者分为建模组(n=204)和验证组(n=102)。计算患者CONUT评分。按CONUT评分将患者分为4组,0~1分为正常组(n=174),2~4分为轻度营养不良组(n=15),5~8分为中度营养不良组(n=104),9~12分为重度营养不良组(n=13)。按照预测总分将所有患者分为4组,即0~184分组(n=96)、185~250分组(n=92)、251~305分组(n=45)、306~500分组(n=73)。采用Cox回归模型对影响患者生存情况的指标进行单因素和多因素分析。采用Schoenfeld残差图和方差膨胀因子对Cox回归模型及多重共线性进行验证和评价。计算预测模型预测1年生存情况的准确度和C-指数、曲线下面积,绘制校准曲线评价预测模型的校准度。结果Cox回归模型分析结果显示,患者年龄、肿瘤分期、丙氨酸转氨酶、血清白蛋白、肿瘤大小、CA199和CONUT评分为总存活期的独立预测因素(P<0.05)。不同CONUT评分各组存活率比较,差异均有统计学意义(P<0.05)。按照预测模型计算分层各组存活率比较,差异均有统计学意义(P<0.05)。模型预测存活率和实际存活率之间有良好的一致性及准确度。结论CONUT评分是晚期胰腺癌患者生存预后的独立预测因素,不同CONUT评分的患者在总体生存情况存在显著差异,基于CONUT评分的临床预测模型对晚期胰腺癌患者的生存预测具有较好的区分度和校准度。
Objective To construct a clinical prediction model based on controlling nutritional status(CONUT)score and verify its prognostic value in patients with advanced pancreatic cancer.Methods A retrospective study was performed on 306 cases of patients with advanced pancreatic cancer who were admitted from January 2010 to December 2018.Patients were randomly divided into the modeling group(n=204)and the validation group(n=102).The patient′s CONUT score was calculated.Patients were divided into 4 groups according to CONUT score,patients with 0~1 score were in the normal group(n=174),patients with 2~4 scores were in the mild malnutrition group(n=15),patients with 5~8 scores were in the moderate malnutrition group(n=104)and patients with 9~12 scores were in the severe malnutrition group(n=13).According to the predicted total score,all patients were divided into 4 groups,namely 0~184 scores group(n=96),185~250 scores group(n=92),251~305 scores group(n=45)and 306~500 scores group(n=73).The Cox regression model was used to analyze the single factor and multiple factor indicators affecting the survival of patients.Schoenfeld residuals and variance inflation factor were used to verify and evaluate the Cox regression model and multicollinearity.Calculate the accuracy of the prediction model to predict 1-year survival,C-index and area under the curve,draw the calibration curve to evaluate the calibration degree of the prediction model.Results Cox regression model analysis showed that age,tumor stage,alanine aminotransferase,serum albumin,tumor size,CA199 and CONUT score were independent predictors of overall survival(P<0.05).The survival rate of all groups with different CONUT scores was statistically significant(P<0.05).The survival rate of each stratified group was calculated according to the prediction model(P<0.05).The model has good consistency and accuracy between the predicted survival rate and the actual survival rate.Conclusion CONUT score is an independent predictor of survival and prognosis in patients with advanced pancreatic cancer.Patients with different CONUT scores have significant differences in overall survival,and the clinical prediction model based on CONUT score has good differentiation and calibration degree for survival prediction of patients with advanced pancreatic cancer.
作者
马作红
宫学宇
尚海
郝志强
傅熙博
冯照强
白雪
华向东
MA Zuo-hong;GONG Xue-yu;SHANG Hai;HAO Zhi-qiang;FU Xi-bo;FENG Zhao-qiang;BAI Xue;HUA Xiang-dong(Department of Hepatobiliary and Pancreatic Surgery,Cancer Hospital of China Medical University,Liaoning Cancer Hospital&Institute,Shenyang110000,China)
出处
《临床军医杂志》
CAS
2020年第7期787-790,共4页
Clinical Journal of Medical Officers
关键词
胰腺癌
列线图
控制营养状况评分
预测模型
Pancreatic cancer
Nomogram
Controlling nutritional status score
Prediction model
