早期宫颈鳞癌盆腔淋巴结转移的预测模型构建
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西南医科大学附属医院妇科

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onstruction of a prediction model for pelvic lymph node metastasis in early-stage cervical squamous cell carcinoma
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    摘要:

    目的:构建早期宫颈鳞癌盆腔淋巴结转移的预测模型。方法:收集2019年1月至2023年10月我院妇科早期宫颈鳞癌患者临床资料。以盆腔淋巴结病检结果为结局指标,进行单因素Logistic分析,向前和向后逐步回归分析得到2个模型。应用赤池信息准则(AIC)、连续净重新分类改善指数(NRI)和综合判别改善指数(IDI)确定最优模型,并转换为列线图。使用受试者工作特征曲线下面积(AUC)、Hosmer-Lemeshow检验、校准曲线、临床决策曲线(DCA)评价模型。Bootstrap 自抽样 1000 次进行内部验证。结果:共纳入221例患者,建立模型1和模型2。根据AIC、连续NRI与IDI结果,确定模型2为最优模型(纳入指标:年龄、SCCA、CA125、MRI淋巴结状态)。模型AUC为0.818;Hosmer-Lemeshow检验χ2=0.942,P=0.332;校正后AUC为0.800;DCA显示阈值概率在0.03-0.5时,临床净受益较高;内部验证Bootstrap 1000次的AUC为0.784。结论:基于年龄、SCCA、CA125以及MRI淋巴结状态构建的模型有助于术前预测早期宫颈鳞癌盆腔淋巴结状态。

    Abstract:

    Objective: To construct a model for predicting pelvic lymph node metastasis in early-stage cervical squamous cell carcinoma. Method:The clinical data of patients in the Department of Gynecology, Affiliated Hospital of Southwest Medical University from January 2019 to October 2023 were retrospectively analyzed. Two models were obtained by univariate logistic analysis , forward and backward stepwise regression analysis. The Akaike Information Criterion (AIC), Continuous Net Reclassification Improvement Index (NRI) and Integrated Discriminant Improvement Index (IDI) were used to determine the optimal model .The model was converted into a nomogram, and its efficacy was evaluated by the area under the receiver operating characteristic curve(AUC), Hosmer-Lemeshow test, calibration curve and clinical decision curve (DCA). Bootstrap self-samples 1000 times for internal validation. Results: A total of 221 patients were enrolled. Forward and backward stepwise regression methods were used to establish model 1 and model 2. According to the results of AIC, serial NRI and IDI, model 2 was the optimal model (indicators: age, SCCA, CA125, and lymph node status on MRI). The AUC was 0.818 ; The Hosmer-Lemeshow test χ2=0.942, P=0.332, and the adjusted AUC was 0.800 ; DCA showed that when the threshold probability was 0.03-0.5, the clinical net benefit was higher. The AUC of the internal verification was 0.784. Conclusion:Models based on age, SCCA, CA125, and MRI lymph node status can help predict pelvic lymph node status for cervical cancer before surgery.

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  • 收稿日期:2024-12-23
  • 最后修改日期:2025-03-26
  • 录用日期:2025-09-12
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