微信公众号

官网二维码
中国癌症防治杂志

中国癌症防治杂志 ›› 2021, Vol. 13 ›› Issue (5): 523-528.doi: 10.3969/j.issn.1674-5671.2021.05.13

• 临床研究 • 上一篇    下一篇

胰头癌根治性胰十二指肠切除术后早期复发预测模型的建立与应用

  

  1. 郴州市第四人民医院普外科
  • 出版日期:2021-10-25 发布日期:2021-11-17
  • 通讯作者: 周大为 E-mail：nikeyou_dr120@163.com
  • 基金资助:
    郴州市科技计划项目（2017jd93）

 Construction and application of an early recurrence prediction model for pancreatic head cancer after radical pancreaticoduodenectomy

  • Online:2021-10-25 Published:2021-11-17

PDF (PC)

136

赞

摘要： 目的 构建可预测胰头癌根治性胰十二指肠切除术后早期复发的列线图模型，并评估其应用价值。方法 本研究为一项回顾性队列研究，选择2017年6月—2019年7月在本院行胰头癌根治性胰十二指肠切除术的患者为研究对象。研究结局为术后早期复发，采用单因素和多因素logistic回归分析早期复发的影响因素，并基于影响因素构建列线图模型。采用受试者工作特征（ROC）曲线下面积（AUC）评估列线图模型的区分度，校准曲线和Hosmer-Lemeshow检验评估校准度，决策曲线评估临床应用价值。结果 共137例患者符合标准纳入最终分析，术后早期复发58例（42.3%）。多因素logistic回归显示，肿瘤大小≥3 cm、术前CA19-9水平>37 U/mL、肿瘤分化程度低分化和淋巴结转移数目>3枚是影响患者术后早期复发的危险因素（均P<0.05），基于这些因素成功构建了列线图模型，AUC为0.807 （95%CI：0.729~0.885），校准曲线Hosmer-Lemeshow检验表明模型具有良好的校准度（P=0.569）。决策曲线显示，列线图具有良好的临床应用价值，即预测早期复发概率达到22%时，可采取干预。结论 本研究成功构建可预测胰头癌根治性胰十二指肠切除术后早期复发的列线图模型，有助于临床早期筛选并识别风险患者。

关键词: 胰头癌, 根治性胰十二指肠切除术, 早期复发, 列线图

Abstract: Objective To construct a nomogram model for predicting the early recurrence of pancreatic head cancer after radical pancreaticoduodenectomy and to evaluate its application value. Methods This retrospective cohort study selected patients who underwent radical pancreaticoduodenectomy for pancreatic head cancer in our hospital from June 2017 to July 2019 as the research objects. The outcome of the study was early postoperative recurrence. The influencing factors of early recurrence were analyzed by univariable and multivariable logistic regression, and a nomogram model was constructed based on the influencing factors. The discrimination of the nomogram model was evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC)  curve, the calibration was evaluated by the calibration curve and Hosmer-Lemeshow test, and the value of clinical application was evaluated by the decision curve. Results A total of 137 patients met the criteria were included in the final analysis. 58 patients (42.3%) had early recurrence after surgery. Multivariable logistic regression showed that tumor size ≥3 cm, preoperative CA19-9 level >37 U/mL, poorly differentiated tumor and the number of lymph node metastases >3 were risk factors affecting the early postoperative recurrence (all P<0.05). Based on these factors, a nomogram model was successfully constructed. The AUC was 0.807 (95%CI: 0.729-0.885). The Hosmer-Lemeshow test of the calibration curve showed that the model had a good calibration degree (P=0.569). The decision curve showed that the nomogram had good clinical application value, and intervention could be taken when the early recurrence probability reached 22%. Conclusions A nomogram model is successfully constructed for predicting the early recurrence of pancreatic head cancer after radical pancreaticoduodenectomy, and it is helpful in the early clinical screening and identification of patients at risk.

Key words: Pancreatic head cancer, Radical pancreaticoduodenectomy, Early recurrence, Nomogram

中图分类号: 

  • R735.9