摘要
目的:分析局部晚期子宫颈癌(LACC)放化疗后的复发危险因素,并构建风险列线图预警模型。方法:回顾性选取2016年5月至2019年12月安徽医科大学第一附属医院肿瘤放疗科收治的320例LACC患者作为研究对象,设为训练集,并按照相同标准选取2020年1月至2020年8月的52例LACC患者设为验证集。分析所选LACC患者的临床资料,采用单因素和Logistic回归分析筛选LACC患者放化疗后复发的危险因素,采用R软件构建列线图预警模型并进行拟合优度检验。结果:本研究共纳入320例LACC患者,经相关检查确认放化疗后复发有64例,其发生率为20.0%;训练集临床资料对比显示FIGO分期、分化程度、肿瘤直径、盆腔淋巴结是否转移、浸润深度、鳞状细胞癌抗原(SCC-Ag)水平、D-二聚体差异有统计学意义(P<0.05);Logistic回归分析结果表明,中低分化(OR2.170,95%CI 1.177~4.001,P=0.013)、肿瘤直径>4 cm(OR2.061,95%CI 1.117~3.803,P=0.021)、盆腔淋巴结转移(OR2.370,95%CI 1.289~4.355,P=0.005)、浸润深度≥1/2(OR2.505,95%CI 1.360~4.614,P=0.003)、SCC-Ag>1.5μg/L(OR2.139,95%CI 1.149~3.982,P=0.016)、D-二聚体>0.5 mg/L(OR2.532,95%CI 1.368~4.687,P=0.003)是LACC放化疗后复发的独立危险因素;基于6项独立危险因素构建LACC放化疗后复发的列线图模型内外部验证结果显示,训练集和验证集的C-index为0.824和0.811,两集的校正曲线的预测值与实测值基本一致,AUC为0.804和0.792。结论:中低分化、肿瘤直径>4 cm、盆腔淋巴结转移、浸润深度≥1/2、SCC-Ag>1.5μg/L、D-二聚体>0.5 mg/L是LACC患者放化疗后复发的独立危险因素,基于上述危险因素建立的列线图模型可准确评估和量化LACC放化疗后复发的风险。
Objective:To analyze the risk factors for recurrence of locally advanced cervical cancer(LACC)af-ter radiotherapy and chemotherapy,and construct an early warning model by designing a risk nomogram.Meth-ods:A total of 320 LACC patients admitted to the Department of Radiation Oncology,The First ffilited Hospital of Anhui Medical University from May 2016 to December 2019 were retrospectively selected as the training set,and 52 LACC patients admitted between January 2020 and August 2020 were included into the validation set ac-cording to the same criteria.The clinical data of selected LACC patients were analyzed.Univariate and Logistic re-gression analysis were used to screen the risk factors for recurrence in L ACC patients after radiotherapy and chemotherapy,and R software was used to construct a nomogram warning model and conduct goodness-of-fit test.Results:A total of 320 L ACC patients were included in this study,while 64 cases of recurrence after radio-therapy and chemotherapy were confirmed by relevant tests,presenting an incidence rate of 20.0%.Comparison of the clinical data in training set revealed that FIGO staging,degree of differentiation,tumor diameter,pelvic lymph node metastasis,and depth of invasion,SCC-Ag level,D-dimer data were significantly different(P<0.05);Logistic regression analysis showed that moderately and poorly differentiated(OR=2.170,95%CI 1.177-4.001,P=0.013),tumor diameter>4 cm(OR=2.061,95%CI 1.117-3.803,P=0.021),pelvic lymph node metastasis(OR=2.370,95%CI 1.289-4.355,P=0.005),depth of invasion≥1/2(OR=2.505,95%CI.1.360-4.614,P=0.003),SCC-Ag>1.5μg/L(OR=2.139,95%CI 1.149-3.982,P=0.016),D-dimer>0.5 mg/L(OR=2.532,95%CI 1.368-4.687,P=0.003)were independent risk factors for recurrence after LACC chemoradiotherapy.A nomogram model for recurrence in L ACC patients after chemoradiotherapy was con-structed based on the six independent risk factors.The internal and external validation results showed that the C-index of the training set and the validation set were 0.824 and 0.811,the predicted values of the calibration curves of the two sets were basically consistent with the measured values,and the AUC were 0.804 and 0.792 respectively.Conclusions:Moderately and poorly differentiated,tumor diameter>4 cm,pelvic lymph node metas-tasis,depth of invasion≥1/2,SCC-Ag>1.5μg/L,D-dimer>0.5 mg/L are independent risk factors of recurrence after radiotherapy and chemotherapy in LACC patients.A nomogram model based on the above risk factors can accurately assess and quantify the risk of recurrence in LACC patients after chemoradiotherapy.
作者
洪文翠
吕银
HONG Wencui;LV Yin(Department of Radiation Oncology,The First Affliated Hospital of Anhui Medical University,Hefei Anhui 230000,China;Department of Radiation Oncology,Fuyang Hospital filited to Anhui Medical University,Fuyang Anhui 236000,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2023年第4期302-307,共6页
Journal of Practical Obstetrics and Gynecology
基金
中华国际医学交流基金会先声临床科研专项基金(编号:Z-2014-06-19413)。
关键词
局部晚期子宫颈癌
复发
放化疗
危险因素
预测模型
Locally advanced cervical cancer
Recurrence
Radiotherapy and chemotherapy
Risk factor
Lorecasting model
