声门上型喉癌手术患者预后的预测模型构建

doi:10.3760/cma.j.issn.1007-1245.2024.11.008

摘要/Abstract

摘要：

目的　构建并验证声门上型喉癌行经口径路低温等离子射频消融术患者预后的预测模型。方法　前瞻性选取2018年1月至2021年1月渭南市第一医院收治的128例声门上型喉癌患者为研究对象，按照8∶2随机分为训练集（103例）和验证集（25例）。训练集男66例、女37例，年龄（53.95±9.03）岁，肿瘤分期：Ⅱ期82例、Ⅲ期21例；验证集男18例、女7例，年龄（54.86±8.69）岁，肿瘤分期：Ⅱ期20例、Ⅲ期5例。患者均给予经口径路低温等离子射频消融术，术后随访3年，记录复发情况。分析影响声门上型喉癌行经口径路低温等离子射频消融术患者预后的因素，建立预测模型，并进行模型的验证及效能评估。采用t检验、χ²检验进行统计分析，影响因素的分析采用logistic回归模型。结果　训练集中有21.36%（22/103）患者术后出现复发，验证集中有20.00%（5/25）患者术后出现复发。logistic回归分析显示肿瘤分期（OR=5.171，95%CI：2.128～12.566）、分化程度（OR=4.764，95%CI：1.960～11.577）、血管内皮生长因子（VEGF）水平（OR=3.892，95%CI：1.602～9.459）是影响声门上型喉癌经口径路低温等离子射频消融术患者预后的因素（均P<0.05）。以上述影响因素作为预测变量，建立列线图预测模型，各因素总分范围83～278分，对应风险率范围为0.07～0.52。列线图模型验证结果显示C-index指数为0.801（95%CI：0.759～0.829），预测声门上型喉癌行经口径路低温等离子射频消融术患者预后的校正曲线趋近于理想曲线（P>0.05）。训练集受试者操作特征曲线（ROC）结果显示：列线图模型预测声门上型喉癌经口径路低温等离子射频消融术患者预后的灵敏度为77.27%，特异度为83.95%，曲线下面积（AUC）为0.854（95%CI：0.772～0.935）。验证集ROC结果显示：列线图模型预测声门上型喉癌经口径路低温等离子射频消融术患者预后的灵敏度为80.00%，特异度为85.00%，AUC为0.872（95%CI：0.793～0.945）。结论　肿瘤分期、分化程度、VEGF水平与声门上型喉癌经口径路低温等离子射频消融术患者预后关系密切，基于此构建的预测模型效能良好。

关键词:

声门上型喉癌, 经口径路低温等离子射频消融术, 预后, 列线图模型

Abstract:

Objective　To construct and verify the prognostic mode for patients with supraglottic laryngeal carcinoma undergoing aperture low temperature plasma radiofrequency ablation. Methods　One hundred and twenty-eight patients with supraglottic laryngeal carcinoma admitted to Weinan First Hospital from January 2018 to January 2021 were selected as the study objects, and were randomly divided into a training set (103 cases) and a validation set (25 cases) according to 8∶2. There were 66 males and 37 females in the training set; they were (53.95±9.03) years old; there were 82 cases of stage Ⅱ and 21 cases of stage Ⅲ. There were 18 males and 7 females in the verification set; they were (54.86±8.69) years old; there were 20 cases of stage Ⅱ and 5 cases of stage Ⅲ. All the patients took aperture low temperature plasma radiofrequency ablation, and were followed up for 3 years after the surgery, and the recurrence was recorded. The factors influencing the patients' prognosis were analyzed, and a prognostic mode was established, validated, and evaluated. t and χ² test were used. The logistic regression model was used to analyze the influencing factors. Results　Postoperative recurrence occurred in 21.36% (22/103) patients in the training set and in 20.00% (5/25) patients in the verification set. The logistic regression analysis showed that tumor stage (OR=5.171; 95%CI 2.128-12.566), differentiation degree (OR=4.764; 95%CI 1.960-11.577), and vascular endothelial growth factor (VEGF) level (OR=3.892; 95%CI 1.602-9.459) were the patients' prognostic factors (all P<0.05). The above influencing factors were used as predictive variables, and a nomogram prediction mode was established. The total score of each factor ranged from 83 to 278, and the corresponding risk rate ranged from 0.07 to 0.52. The results of the nomogram mode showed that the C-index was 0.801 (95%CI 0.759-0.829), and the correction curve for predicting the patients' prognosis was close to the ideal curve (P>0.05). The receiver operating characteristic curve (ROC) results of the training set showed that the sensitivity, specificity and AUC of the nomogram mode for predicting the patients' prognosis were 77.27%, 83.95%, and 0.854 (95%CI 0.772-0.935). The ROC results of the validation set showed that the sensitivity, specificity and AUC of the nomogram mode for predicting the patients' prognosis were 80.00%, 85.00%, and 0.872 (95%CI 0.793-0.945). Conclusions　Tumor stage, differentiation degree, and VEGF level are closely related to the prognosis of patients with supraglottic laryngeal carcinoma undergoing aperture low-temperature plasma radiofrequency ablation. The prediction mode is effective in predicting the prognosis of patients with supraglottic laryngeal carcinoma undergoing aperture low-temperature plasma radiofrequency ablation.

Key words:

Supraglottic laryngeal carcinoma, Cryoplasma radiofrequency ablation via aperture, Prognosis, Nomogram model

张寒张胜利祖媛媛.

声门上型喉癌手术患者预后的预测模型构建 [J]. 国际医药卫生导报, 2024, 30(11): 1796-1801.

Zhang Han, Zhang Shengli, Zu Yuanyuan.

Construction of prognostic mode for patients with supraglottic laryngeal carcinoma undergoing surgery [J]. International Medicine and Health Guidance News, 2024, 30(11): 1796-1801.

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