胆囊癌根治手术成功实施列线图预测模型的建立和验证

doi:10.11958/20231560

天津医药 ›› 2024, Vol. 52 ›› Issue (5): 536-540.doi: 10.11958/20231560

胆囊癌根治手术成功实施列线图预测模型的建立和验证

郑康鹏(), 唐鑫国, 徐琦, 樊钰亭, 梁博, 付晓伟, 方路^△()

南昌大学第二附属医院肝胆外科（邮编330006）

收稿日期:2023-10-13 修回日期:2023-11-06 出版日期:2024-05-15 发布日期:2024-05-09
通讯作者: ^△ E-mail：fanglu@medmail.com.cn
作者简介:郑康鹏（1997），男，住院医师，主要从事肝胆胰腺的临床方面研究。E-mail：zkp2016140243@126.com
基金资助:
国家自然科学基金资助项目(82160578);江西省卫生健康委科技计划项目(202210033)

Nomogram construction and validation for predicting the possibility successful implementation of radical surgery in gallbladder cancer patients

ZHENG Kangpeng(), TANG Xinguo, XU Qi, FAN Yuting, LIANG Bo, FU Xiaowei, FANG Lu^△()

Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China

Received:2023-10-13 Revised:2023-11-06 Published:2024-05-15 Online:2024-05-09
Contact: ^△ E-mail：fanglu@medmail.com.cn

郑康鹏, 唐鑫国, 徐琦, 樊钰亭, 梁博, 付晓伟, 方路. 胆囊癌根治手术成功实施列线图预测模型的建立和验证[J]. 天津医药, 2024, 52(5): 536-540.

ZHENG Kangpeng, TANG Xinguo, XU Qi, FAN Yuting, LIANG Bo, FU Xiaowei, FANG Lu. Nomogram construction and validation for predicting the possibility successful implementation of radical surgery in gallbladder cancer patients[J]. Tianjin Medical Journal, 2024, 52(5): 536-540.

摘要/Abstract

摘要：

目的建立可预测胆囊癌（GBC）患者根治性手术成功实施的列线图并进行初步验证。方法纳入320例行手术治疗（包括根治性手术、姑息性切除术、腹腔探查术和活检术）的GBC患者。根据纳入时间先后分为训练集（235例）和验证集（85例）。比较实施根治性手术和非根治性手术患者的临床资料，多因素Logistic回归分析影响GBC患者根治性手术成功实施的因素，并绘制列线图预测模型。采用受试者工作特征（ROC）曲线和校准曲线评价预测模型的区分度及校准度，应用临床决策曲线（DCA）评估列线图预测模型的实际效用。结果单因素分析显示，根治性手术组和非根治性手术组在体质量减轻、黄疸、高血压、淋巴结转移、体质量指数、血红蛋白（HB）、白蛋白（ALB）、糖类抗原（CA）19-9、CA125、总胆红素和直接胆红素差异有统计学意义（P<0.05）。将这11个潜在的预测因素在训练集纳入多因素Logistic回归分析，结果显示无黄疸、高血压、淋巴结转移，HB、ALB升高，CA19-9降低是预测GBC根治手术成功实施的因素。根据Logistic回归得到的6个独立风险因素建立列线图。在训练组和验证组中，列线图的曲线下面积分别为0.901和0.822，模型具有良好的区分度。Hosmer-Lemeshow检验表明模型校准度良好（χ²=5.740，P=0.676）。模型校准曲线均接近理想曲线，表明观察结果与实际结果吻合良好。DCA曲线显示模型对临床使用具有净效益和良好的临床实用性。结论该列线图可有效筛选适合根治性手术的GBC患者，减少预期根治性手术转为姑息性切除或剖腹探查术的机会，增加患者手术获益的可能性。

关键词: 胆囊肿瘤, 列线图, 黄疸, 高血压, CA-19-9抗原, 根治性手术, 危险因素

Abstract:

Objective To develop a nomogram for predicting the successful implementation of radical surgery for gallbladder cancer (GBC). Methods A total of 320 patients with GBC who underwent surgical procedures including radical surgery, palliative excision, abdominal exploration, and biopsy were enrolled in this study. Patients were divided into the training set (235 cases) and the verification set (85 cases) according to the time of inclusion. By comparing the clinical data of patients undergoing radical surgery and patients with non-radical surgery, multivariate Logistic regression analysis was conducted to analyze the prediction model affecting the successful implementation of radical surgery in GBC patients, and a column graph was drawn. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the differentiation and calibration of the prediction model. Clinical decision curve (DCA) was used to evaluate the practical utility of the nomogram prediction model. Results Univariate analysis showed that there were significant differences in weight loss, jaundice, hypertension, lymph node metastasis, body mass index (BMI), hemoglobin (HB), albumin (ALB), CA19-9, CA125, total bilirubin and direct bilirubin between the radical surgery group and the non-radical surgery group (P<0.05). These 11 potential predictors were included in the multivariate Logistic regression analysis in the training set, and results showed that no jaundice, hypertension, lymph node metastasis, elevated HB and ALB, and decreased CA19-9 were predictive factors for the successful implementation of radical GBC surgery. A nomogram was established based on 6 independent risk factors obtained by Logistic regression. In the training group and the verification group, the area under the curve of the nomogram was 0.901 and 0.822, respectively, and the model has good differentiation. Hosmer-Lemeshow test showed that the model was well calibrated (χ²=5.740, P=0.676). The calibration curve of the model was close to ideal curve, indicating that the observed results were in good agreement with the actual results. The DCA curve showed that the model had a net benefit and good clinical practicability for clinical application. Conclusion The nomogram can effectively screen patients with GBC suitable for radical surgery, thus reducing the chance of conversion of anticipated radical surgery to palliative resection or exploratory laparotomy and increasing the likelihood of surgical benefits for patients.

Key words: gallbladder neoplasms, nomograms, jaundice, hypertension, CA-19-9 antigen, radical surgery, risk factors

中图分类号:

R735.8

图/表 7

表1 训练集和验证集行不同手术T分期分布情况例

Tab.1 The training set and the verification set of different surgical T stage distribution of radical and non-radical treatment

组别	n	手术类型	Tis+T1a	T1b	T2	T3	T4
训练集	235	R0切除	13	14	32	38	4
		姑息性切除	0	0	17	52	13
		腹腔探测或活检	0	0	0	36	16
验证集	85	R0切除	6	8	11	13	1
		姑息性切除	0	0	7	18	4
		腹腔探测或活检	0	0	0	13	4

表2 训练集2组临床资料比较

Tab.2 Comparison of clinical data between the two groups of the training set group

表3 根治性手术成功实施的多因素Logistic回归分析

Tab.3 Multivariate Logistic regression analysis of successful implementation of radical surgery

变量	β	SE	Wald χ²	P	OR（95%CI）
黄疸	-2.333	0.617	14.301	<0.001	0.097（0.029~0.325）
高血压	-1.135	0.572	3.940	0.047	0.322（0.105~0.986）
淋巴结转移	-1.496	0.553	7.314	0.007	0.224（0.076~0.663）
HB	0.048	0.018	7.415	0.006	1.050（1.014~1.087）
ALB	0.322	0.079	16.590	<0.001	1.380（1.182~1.610）
CA19-9	-0.004	0.001	9.877	0.002	0.996（0.994~0.999）
常数项	-17.713	3.916	20.459	<0.001	0.000

图1 GBC根治性手术成功实施的列线图预测模型

Fig.1 Nomogram for predicting the successful implementation of radical surgery of GBC

图2 GBC患者实施根治性手术预测模型的ROC曲线

Fig.2 ROC curve of prediction model for GBC patients undergoing radical surgery

图3 GBC患者实施根治性手术预测模型的校准曲线

Fig.3 Calibration curve of prediction model for radical surgery in GBC patients

图4 GBC患者实施根治性手术预测模型的DCA曲线

Fig.4 DCA curve of GBC patients undergoing radical surgery prediction model

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胆囊癌根治手术成功实施列线图预测模型的建立和验证

Nomogram construction and validation for predicting the possibility successful implementation of radical surgery in gallbladder cancer patients

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