早期宫颈鳞癌盆腔淋巴结转移的预测模型构建
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1西南医科大学附属医院妇科,四川 泸州 646000 ; 2.西南医科大学附属中医医院妇科,四川 泸州 646000 ; 3.西南医科大学附属天府医院妇产科,四川 眉山 620000

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R737.33

基金项目:

四川省中医药管理局科学技术研究专项课题(2023MS524)


Construction of a prediction model for pelvic lymph node metastasis in early ⁃ stage cervical squamous cell carcinoma
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1Department of Gynecology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000 ; 2.Department ofGynecology,the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou 646000 ; 3.Department of Obstetrics and Gynecology,the Affiliated Tianfu Hospital of Southwest Medical University,Meishan 620000 ,China

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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—2023年10月西南医科大学附属医院妇科早期宫颈鳞癌患者的临床资料。以盆腔淋巴结病理检查结果为结局指标,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。应用赤池信息量准则(Akaike information criterion,AIC)、连续净重新分类改进指数(net reclassification improvement,NRI)和综合判别改善指数(integrated discriminant improvement,IDI)确定最优模型,并将最优模型转换为列线图。使用受试者工作特征曲线下面积(area under the curve,AUC)、Hosmer-Lemeshow检验、校准曲线、临床决策曲线(decision curve analysis,DCA)对模型进行评价。使用Bootstrap 自助法对模型进行内部验证。结果:本研究共纳入221例患者,建立模型 1和模型2。根据AIC、连续NRI与IDI结果对模型进行评价,确定模型2为最优模型[纳入指标:年龄、鳞状上皮细胞癌抗原 (squamous cell carcinoma antigen,SCCA)、糖类抗原(carbohydrate antigen,CA)125、磁共振成像淋巴结状态]。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0.03~0.50时,临床净受益值较高; Bootstrap内部验证的AUC为0.784。结论:基于年龄、SCCA、CA125以及磁共振成像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. Methods: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. A univariate logistic analysis was performed based on the pathological examination results of pelvic lymph nodes as the outcome indicator. Two models were developed by univariate logistic analysis as well as 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 optimal model was then 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 decision curve analysis(DCA). Bootstrap method was used 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,respectively. According to the results of AIC,serial NRI and IDI,model 2 was the optimal model [indicators:age,squamous cell carcinoma antigen(SCCA),carbohydrate antigen(CA)125 and lymph node status on magnetic resonance imaging]. The AUC was 0.818;the Hosmer-Lemeshow test results were χ2 =0.942 and P=0.332,and the adjusted AUC was 0.800. DCA results showed that when the threshold probability was 0.03-0.50,the clinical net benefit was relatively high. The AUC of the internal verification of Bootstrap was 0.784. Conclusion:Models based on age,SCCA,CA125,and lymph node status in magnetic resonance imaging can help predict pelvic lymph node status for cervical cancer before surgery.

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李俊玫,王露,毛熙光,廖思静.早期宫颈鳞癌盆腔淋巴结转移的预测模型构建[J].南京医科大学学报(自然科学版),2025,45(10):1467-1475

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  • 收稿日期:2024-12-23
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  • 在线发布日期: 2025-10-16
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