基于影像组学的胃癌术前阳性淋巴结比率预测模型的研究
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1.<2.sup>3.南京医科大学第一附属医院<4./sup>

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国家自然科学基金面上项目(编号:82373335); 江苏省科教能力提升工程(江苏省医学重点学科,ZDXK202222)


Prediction Model for Positive Lymph Node Ratio Based on RadiomicsLingchi Chen1,2, Qianzheng Zhou1, Qiong Li1, Fengyuan Li1, Hao Xu1*
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    摘要:

    目的 基于影像组学提取的特征建立对于胃癌患者阳性淋巴结比率(Lymph node ratio,LNR)的预测模型,并结合其他临床因素构建列线图用于预测胃癌患者术前LNR状态,以帮助制定更加精准额临床决策。 方法 收集2014年1月至2018年12月南京医科大学第一附属医院根治性胃癌手术患者(n=380)的临床资料,筛选出术后病理淋巴结转移阳性的病人,分析术前影像资料,提取特征后进行机器学习,选择了三种模型:支持向量机(Support Vector Machine, SVM)、随机森林(Random Forest, RF)、逻辑回归(Logistic Regression, LR),最后选择经ROC曲线验证效能最佳的随机森林模型作为模型预测结果,结合多因素Logistic分析有意义的临床指标,一起构建了列线图以用来预测患者术后LNR高低。结果 LNR高低是影响胃癌切除术后患者预后的独立危险因素,基于术前影像组学及临床信息提取了RF评分(p<0.01)、性别(p=0.025)、cN分期(p<0.01)三个因子,并据此建立了列线图模型,并绘制ROC曲线(曲线下面积即AUC值为0.818)和DCA曲线检验效能。结论 基于影像组学和临床信息建立的列线图模型对LNR有较好的预测效能,帮助临床制定个性化的临床治疗策略。

    Abstract:

    Objective To develop a predictive model for the lymph node ratio (LNR) in gastric cancer patients based on radiomics features extracted from preoperative imaging, and to construct a nomogram incorporating clinical factors to preoperatively predict LNR status. This model aims to assist in making more precise clinical decisions for gastric cancer treatment. Methods Clinical data of patients(n=380) who underwent radical gastrectomy at the First Affiliated Hospital of Nanjing Medical University between January 2014 and December 2018 were retrospectively collected. Patients with pathologically confirmed lymph node metastasis were selected. Preoperative imaging data were analyzed to extract radiomic features, followed by machine learning modeling. Three algorithms—Support Vector Machine (SVM), Random Forest (RF), and Logistic Regression (LR)—were evaluated. The RF model, which demonstrated the best performance based on the ROCcurve analysis, was selected for prediction. A nomogram was then developed using the RF score and clinically significant variables identified by multivariate logistic regression analysis. Results LNR was identified as an independent prognostic factor for patients undergoing gastric cancer resection. Three variables—RF score (p < 0.01), sex (p = 0.025), and clinical N stage (p < 0.01)—were included in the final nomogram model. The model’s performance was evaluated using ROC (The AUC value = 0.818)and decision curve analysis (DCA), both of which demonstrated good predictive ability. Conclusion The nomogram model based on radiomic and clinical information provides favorable predictive accuracy for preoperative LNR status in gastric cancer patients.

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  • 收稿日期:2025-07-23
  • 最后修改日期:2025-09-10
  • 录用日期:2025-10-29
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