摘要
目的探讨早期食管癌及癌前病变行内镜黏膜下剥离术(endoscopic submucosal dissec-tion,ESD)后发生食管狭窄的高危险因素,尝试以此构建预测模型并加以验证。方法2015年1月—2020年4月在郑州大学第一附属医院消化内科行ESD治疗,经病理确诊的421例早期食管癌及癌前病变病例纳入回顾性分析,其中发生术后狭窄者89例(狭窄组)、未发生术后狭窄者332例(非狭窄组)。通过单因素联合多因素Logistic回归分析探寻发生术后食管狭窄的危险因素。通过Lasso算法将独立危险因素作为预测因子构建Nomogram模型图,采用一致性指数(C-index)和校准曲线评估模型的准确性,应用Bootstrap完成内部验证以避免模型过拟合。结果单因素分析发现,术后病理、浸润深度、标本中位长径、标本中位短径、黏膜环周缺损范围、固有肌层损伤与发生术后食管狭窄有关(P<0.05)。进一步多因素Logistic回归分析发现,黏膜环周缺损范围≥1/2环周(与<1/2环周比较:P<0.01,OR=48.453,95%CI:11.288~207.983)、固有肌层损伤(P<0.01,OR=4.671,95%CI:2.283~9.557)和纵向长径≥50 mm(与<50 mm比较:P=0.008,OR=2.741,95%CI:1.299~5.785)是ESD术后发生食管狭窄的独立危险因素。通过Lasso算法将以上因素作为预测因子构建Nomogram模型,原始模型的C-index为0.934(95%CI:0.909~0.959),经过100次Bootstrap内部抽样验证后C-index为0.931,该模型预测概率和实际观察概率吻合度较好。结论黏膜环周缺损范围≥1/2环周、发生固有肌层损伤和病灶纵向长径≥50 mm是ESD术后发生食管狭窄的高危险因素,以上3个指标作为预测因子构建的Nomogram模型对早期食管癌及癌前病变ESD术后是否发生食管狭窄的预测效果较好,有助于对术后食管狭窄高风险患者建立提前干预的标准方案。
Objective To investigate the risk factors of esophageal stenosis after endoscopic submucosal dissection(ESD)of early esophageal cancer and precancerous lesions,and to construct and assess a predictive model for esophageal stenosis.Methods Data of 421 patients with early esophageal cancer or precancerous lesions who underwent ESD and were confirmed by pathology in the First Affiliated Hospital of Zhengzhou University between January 2015 and April 2020 were retrospectively analyzed.Eighty-nine cases developed postoperative esophageal stenosis(stenosis group)and 332 cases did not(non-stenosis group).Risk factors of esophageal stenosis were investigated by univariate and multivariate logistic regression analysis.Independent risk factors were used as predictors to construct a nomogram model by using the lasso algorithm.The accuracy of the model was evaluated by the consistency index(C-index)and the calibration curve.Bootstrap was applied to internal verification to avoid over-fitting of the model.Results Univariate analysis showed that postoperative pathology,depth of infiltration,median long and short diameters of the specimen,circumferential resection range,and muscularis propria injury were related to postoperative esophageal stenosis(P<0.05).Further multivariate logistic regression analysis showed that the resection range≥1/2 of the circumference(VS<1/2 circumference:P<0.01,OR=48.453,95%CI:11.288-207.983),muscularis propria injury(P<0.01,OR=4.671,95%CI:2.283-9.557)and longitudinal length≥50 mm(VS<50 mm:P=0.008,OR=2.741,95%CI:1.299-5.785)were independent risk factors for esophageal stenosis after ESD.The nomogram model was constructed through the lasso algorithm by taking the longitudinal length,circumferential resection range,and muscularis propria injury as the predictive factors.The C-index of the nomogram was 0.934(95%CI:0.909-0.959)and was 0.931 after 100 times of Bootstrap internal sampling,which meant the prediction probability of the model in the calibration curve was in good agreement with the actual observation probability.Conclusion Circumferential resection range≥1/2,muscularis propria injury,and longitudinal length≥50 mm are independent risk factors for post-ESD esophageal stenosis.The nomogram model constructed by the above three indicators as predictors shows an ideal prediction effect on esophageal stenosis after ESD for early esophageal cancer and precancerous lesions,which is helpful to establish a standard plan for early intervention in patients at high risk of stenosis after ESD.
作者
刘宁
刘丹
刘冰熔
林锐
Liu Ning;Liu Dan;Liu Bingrong;Lin Rui(Department of Gastroenterology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华消化内镜杂志》
CSCD
2021年第9期728-732,共5页
Chinese Journal of Digestive Endoscopy
关键词
食管狭窄
食管肿瘤
早期食管癌
癌前病变
内镜黏膜下剥离术
诺模图
Esophageal stenosis
Esophageal neoplasms
Early esophageal cancer
Precancerous lesions
Endoscopic submucosal dissection
Nomogram model
