中晚期食管癌支架置入术后支架内再狭窄风险Nomgram模型的建立与评估

金晓昇; 陈璐茜; 李荣洲; 季婷婷; 余伟来; 杨庆

doi:10.16766/j.cnki.issn.1674-4152.002317

中晚期食管癌支架置入术后支架内再狭窄风险Nomgram模型的建立与评估

doi: 10.16766/j.cnki.issn.1674-4152.002317

1.
瑞安市人民医院消化内科，浙江瑞安 325200
2.
瑞安市人民医院输液室，浙江瑞安 325200

基金项目:

浙江省基础公益研究计划项目 LY19H070014

温州市医药卫生科学研究项目 2020033

详细信息

通讯作者:
杨庆，E-mail：33302141@qq.com

中图分类号: R735.1
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- 被引次数: 0
出版历程
- 收稿日期: 2020-11-27
- 网络出版日期: 2022-03-04

Establishment and evaluation of risk nomgram model for in-stent restenosis after stent implantation in metaphase and advanced oesophageal carcinoma

1.
Department of Gastroenterology, Ruian People's Hospital, Ruian, Zhejiang 325200, China

摘要

摘要: 目的通过分析中晚期食管癌患者支架置入术后支架内再狭窄(in-stent restenosis，ISR)发生的相关影响因素，建立并评估个体化预测中晚期食管癌患者支架置入术后ISR发生风险的列线图模型。方法选取2015年5月—2019年6月在瑞安市人民医院消化内科确诊并住院行支架置入术治疗的中晚期食管癌患者160例为研究对象，并根据中晚期食管癌患者支架置入术后ISR的发生与否将研究对象分为术后ISR组(26例)和非术后ISR组(134例)。采用logistic回归模型分析中晚期食管癌患者支架置入术后ISR的独立危险因素。应用列线图在线网站绘制预测中晚期食管癌患者支架置入术后ISR发生风险的列线图模型。采用ROC曲线、校准曲线及Hosmer-Lemeshow拟合优度检验评估列线图模型进行验证。结果 Logistic回归模型显示，年龄大、合并食管瘘、临床分期为Ⅳ期是中晚期食管癌患者支架置入术后ISR发生的独立危险因素(均P＜0.05)，支架置入术后接受放射治疗是中晚期食管癌患者支架置入术后ISR发生的保护因素(P＜0.05)。ROC曲线结果显示，预测中晚期食管癌患者支架置入术后ISR发生风险的AUC为0.869。校准曲线为斜率接近1的直线，Hosmer-Lemeshow拟合优度检验χ²=5.661，P=0.685。结论本研究基于年龄、支架置入术后接受放射治疗、合并食管瘘、临床分期这4项独立影响因素构建的预测中晚期食管癌支架置入术后ISR风险的列线图模型，具有良好的区分度与准确度。
- 中晚期食管癌 /
- 支架置入术 /
- 术后支架内再狭窄 /
- 风险 /
- 评估
Abstract: Objective To analyse the related factors of in-stent restenosis (ISR) after stent implantation in patients with metaphase and advanced oesophageal carcinoma and to establish and evaluate an individual nomogram model for predicting the risk of ISR. Methods From May 2015 to June 2019, 160 patients with metaphase and advanced oesophageal carcinoma who were diagnosed and hospitalised for stent implantation in the Department of Gastroenterology in Ruian People's Hospital were selected as participants. According to the occurrence of ISR after stent implantation, the patients were divided into post-operative ISR group (n=26) and non-postoperative ISR group (n=134). A logistic regression model was used to analyse the independent risk factors of ISR after stent implantation. A nomogram model for predicting the risk of ISR after stent implantation was developed using nomogram online website. The receiver operating characteristic curve (ROC), calibration curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the nomogram model. Results The logistic regression model showed that age, oesophageal fistula and clinical stage were independent risk factors for ISR after stent implantation in patients with metaphase and advanced oesophageal carcinoma (all P < 0.05), and radiotherapy after stent implantation was a protective factor for ISR risk (P < 0.05). ROC results showed that the area under the curve (AUC) for predicting the risk of ISR after stent implantation was 0.869. The calibration curve was a straight line with a slope close to 1, and Hosmer-Lemeshow goodness-of-fit test showed χ²=5.661, P=0.685. Conclusion Based on age, radiotherapy after stent implantation, oesophageal fistula and clinical stage, the nomogram model for predicting the risk of ISR after stent implantation for metaphase and advanced oesophageal carcinoma has good discrimination and accuracy.
- Metaphase and advanced oesophageal carcinoma /
- Stent implantation /
- Post-operative ISR /
- Risk /
- Assessment

HTML全文

图 1 预测中晚期食管癌支架置入术后ISR发生风险的列线图模型

下载: 全尺寸图片幻灯片

图 2 列线图模型预测中晚期食管癌支架置入术后ISR发生风险的ROC曲线

下载: 全尺寸图片幻灯片

图 3 列线图模型预测中晚期食管癌支架置入术后ISR发生风险的验证

下载: 全尺寸图片幻灯片

表 1 2组中晚期食管癌患者临床相关指标比较

组别	例数	年龄(x±s，岁)	性别(男/女，例)	BMI (x±s)	支架置入术后接受放射治疗[例(%)]	合并食管瘘[例(%)]	病变长度(x±s，cm)	临床分期[例(%)]		病变部位[例(%)]
组别	例数	年龄(x±s，岁)	性别(男/女，例)	BMI (x±s)	支架置入术后接受放射治疗[例(%)]	合并食管瘘[例(%)]	病变长度(x±s，cm)	Ⅲ期	Ⅳ期	胸中段	其他
术后ISR组	26	60.32±1.83	16/10	21.91±1.76	7(26.92)	18(69.23)	5.33±1.12	6(23.08)	20(76.92)	17(65.38)	9(34.62)
非术后ISR组	134	59.11±1.95	73/61	22.13±1.59	72(53.73)	49(36.57)	4.95±1.08	72(53.73)	62(46.27)	54(40.30)	80(59.70)
统计量		2.923^a	0.440^b	0.634^a	6.261^b	9.545^b	1.632^a	8.190^b		5.552^b
P值		0.004	0.507	0.527	0.012	0.002	0.105	0.004		0.018
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 2 中晚期食管癌支架置入术后ISR发生的影响因素分析

项目	B	SE	Wald χ²	P值	OR值	95%CI
年龄	1.027	0.302	11.561	0.001	2.794	1.545~5.052
支架置入术后接受放射治疗	-2.758	0.924	8.901	0.003	0.063	0.010~0.388
合并食管瘘	3.700	1.146	10.419	0.001	40.460	4.278~382.667
临床分期	2.229	0.909	6.009	0.014	9.288	1.563~55.182

下载: 导出CSV

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