胆囊癌根治性切除术后复发影响因素及列线图预测模型构建

doi:10.3877/cma.j.issn.2095-3232.2023.02.011

中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (02) : 179 -184. doi: 10.3877/cma.j.issn.2095-3232.2023.02.011

所属专题：临床研究；

临床研究

胆囊癌根治性切除术后复发影响因素及列线图预测模型构建

谭涛¹, 胡志刚², 周兵海², 吴华俊², 余新², 袁荣发², 邹书兵², 王恺³^,^†(

)

^1. 330006　南昌大学第二附属医院肝胆胰外科；412007　湖南省株洲市，中南大学湘雅医院附属株洲医院肝胆胰脾外一科
^2. 330006　南昌大学第二附属医院肝胆胰外科
^3. 330006　南昌大学第二附属医院肝胆胰外科；江西省普通外科疾病临床研究中心

收稿日期:2022-11-23 出版日期:2023-03-28
通信作者: 王恺
基金资助:
国家自然科学基金(82060454)

Influencing factors of recurrence of gallbladder cancer after radical resection and construction of Nomogram prediction model

Tao Tan¹, Zhigang Hu², Binghai Zhou², Huajun Wu², Xin Yu², Rongfa Yuan², Shubing Zou², Kai Wang³^,^†()

^1. Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Nanchang University,; Department Ⅰ of Hepatobiliary, Pancreatic and Spleen Surgery, Affiliated Zhuzhou Hospital of Xiangya Hospital of Central South University, Zhuzhou 412007, China
^2. Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Nanchang University,
^3. Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Nanchang University,; Clinical Research Center for General Surgical Diseases of Jiangxi Province, Nanchang 330006, China

Received:2022-11-23 Published:2023-03-28
Corresponding author: Kai Wang

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引用本文：

谭涛, 胡志刚, 周兵海, 吴华俊, 余新, 袁荣发, 邹书兵, 王恺. 胆囊癌根治性切除术后复发影响因素及列线图预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(02): 179-184.

Tao Tan, Zhigang Hu, Binghai Zhou, Huajun Wu, Xin Yu, Rongfa Yuan, Shubing Zou, Kai Wang. Influencing factors of recurrence of gallbladder cancer after radical resection and construction of Nomogram prediction model[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(02): 179-184.

目的

探讨胆囊癌根治性切除患者术后复发的影响因素及建立预后的列线图预测模型。

方法

本研究对象为2011年3月1日至2019年12月31日南昌大学第二附属医院收治的118例胆囊癌根治性切除术后患者。患者均签署知情同意书，符合医学伦理学规定。其中男34例，女84例；年龄31~83岁，中位年龄61岁；随访期间复发78例。采用Cox比例风险回归模型分析复发独立预测因素，并建立相关列线图预测模型。采用ROC、校正曲线、决策分析曲线评估其预测价值。

结果

多因素Cox回归分析显示，CA19-9升高、T3~T4分期、N1~N2分期是胆囊癌根治性切除术后复发的独立危险因素（HR=2.901，21.462，2.558；P<0.05）。基于3项独立影响因素建立列线图模型的C指数为0.828，该模型对患者术后1、2、3年无复发生存预测的ROC曲线下面积分别为0.90、0.97、0.99，提示列线图模型具有良好的预测能力。校正曲线显示较好的一致性。决策分析曲线显示较好的临床适用性。

结论

CA19-9、T分期、N分期是胆囊癌根治性切除患者术后复发的影响因素，基于影响因素建立的列线图模型具有较好的预测性。

关键词: 胆囊肿瘤, 外科手术, 复发, 列线图, 预测模型

Objective

To investigate the influencing factors of recurrence in patients with gallbladder cancer after radical resection and to establish a Nomogram prediction model for the clinical prognosis.

Methods

118 patients with gallbladder cancer undergoing radical resection in the Second Affiliated Hospital of Nanchang University from March 1, 2011 to December 31, 2019 were recruited in this study. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 34 patients were male and 84 female, aged from 31 to 83 years, with a median age of 61 years. 78 cases recurred during the follow-up. The independent risk factors of recurrence were identified by Cox's proportional hazard regression model, and the Nomogram prediction model was established. The prediction value of this model was assessed by ROC, calibration curve and decision analysis curve.

Results

Multivariate Cox's regression analysis showed that elevated CA19-9, T3-T4 stage and N1-N2 stage were the independent risk factors for the recurrence of gallbladder cancer after radical resection (HR=2.901, 21.462, 2.558; P<0.05). The C-index of Nomogram model based on the 3 risk factors was 0.828. The area under the ROC curve (AUC) of this model for predicting the 1-, 2- and 3-year recurrence-free survival of patients was 0.90, 0.97 and 0.99, indicating that the Nomogram model had high predictive value. The calibration curve showed a high consistency. Decision analysis curve revealed a high application value in clinical practice.

Conclusions

CA19-9, T stage and N stage are the influencing factors of postoperative recurrence of gallbladder cancer after radical resection. The Nomogram model based on these influencing factors yields high predictive value.

Key words: Gallbladder neoplasms, Surgical procedures, operative, Recurrence, Nomogram, Predictive model

表1 胆囊癌根治性切除患者术后复发影响因素Cox回归分析

因素	单因素分析			多因素分析
因素	HR	95%CI	P	HR	95%CI	P
年龄（岁）
50~69	0.963	0.539~1.720	0.898
≥70	0.842	0.442~1.604	0.601
性别（女）	0.650	0.406~1.039	0.071
PLR
150~299	1.616	1.008~2.592	0.046	1.186	0.716~1.963	0.507
≥300	3.879	1.757~8.565	<0.001	1.205	0.518~2.801	0.664
TB升高	1.547	0.960~2.491	0.072
CA19-9升高	3.748	2.282~6.156	<0.001	2.901	1.683~5.001	<0.001
CEA升高	2.809	1.645~4.797	<0.001	1.227	0.677~2.223	0.499
神经侵犯	3.519	2.123~5.834	<0.001	1.633	0.844~3.159	0.145
脉管癌栓	2.556	1.520~2.498	<0.001	0.696	0.373~1.300	0.255
T3~T4分期	40.760	9.878~168.200	<0.001	21.462	4.856~94.856	<0.001
N1~N2分期	9.057	5.071~16.180	<0.001	2.558	1.361~4.807	0.003
低/中低分化	2.853	1.804~4.513	<0.001	1.348	0.778~2.338	0.287
NLR
2.5~4.9	1.399	0.835~2.343	0.202
≥5.0	1.683	0.939~3.014	0.080

表1 胆囊癌根治性切除患者术后复发影响因素Cox回归分析

因素	单因素分析			多因素分析
因素	HR	95%CI	P	HR	95%CI	P
年龄（岁）
50~69	0.963	0.539~1.720	0.898
≥70	0.842	0.442~1.604	0.601
性别（女）	0.650	0.406~1.039	0.071
PLR
150~299	1.616	1.008~2.592	0.046	1.186	0.716~1.963	0.507
≥300	3.879	1.757~8.565	<0.001	1.205	0.518~2.801	0.664
TB升高	1.547	0.960~2.491	0.072
CA19-9升高	3.748	2.282~6.156	<0.001	2.901	1.683~5.001	<0.001
CEA升高	2.809	1.645~4.797	<0.001	1.227	0.677~2.223	0.499
神经侵犯	3.519	2.123~5.834	<0.001	1.633	0.844~3.159	0.145
脉管癌栓	2.556	1.520~2.498	<0.001	0.696	0.373~1.300	0.255
T3~T4分期	40.760	9.878~168.200	<0.001	21.462	4.856~94.856	<0.001
N1~N2分期	9.057	5.071~16.180	<0.001	2.558	1.361~4.807	0.003
低/中低分化	2.853	1.804~4.513	<0.001	1.348	0.778~2.338	0.287
NLR
2.5~4.9	1.399	0.835~2.343	0.202
≥5.0	1.683	0.939~3.014	0.080

图1 胆囊癌根治性切除患者术后复发的列线图模型注：RFS为无复发生存期

图2 胆囊癌根治性切除患者术后复发列线图模型的ROC曲线注：RFS为无复发生存期，AUC为曲线下面积

图3 胆囊癌根治性切除患者术后复发列线图模型的校正曲线注：RFS为无复发生存期

图4 胆囊癌根治性切除患者术后复发列线图模型的决策分析曲线注：a、b、c分别为术后1、2、3年决策分析曲线

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