外科理论与实践 ›› 2024, Vol. 29 ›› Issue (03): 236-242.doi: 10.16139/j.1007-9610.2024.03.09
收稿日期:
2024-04-26
出版日期:
2024-05-25
发布日期:
2024-09-03
通讯作者:
陈希,E-mail:cx11977@rjh.com.cn基金资助:
Gong Tingting, Qian Aihua, Chen Xi()
Received:
2024-04-26
Online:
2024-05-25
Published:
2024-09-03
摘要:
目的:分析早期胃癌内镜黏膜下剥离术(ESD)术后迟发性出血(DPPB)的影响因素并构建列线图模型。方法:收集2021年4月至2023年4月本院行ESD治疗且病理诊断为早期胃癌的234例病人临床资料,依据有无发生DPPB分组,采用Logistic回归分析筛选影响早期胃癌病人ESD后发生DPPB的危险因素;采用R软件构建预测早期胃癌ESD后发生DPPB风险的列线图模型;通过绘制受试者工作特征(ROC)曲线、校准曲线以及Hosmer-Lemeshow拟合优度检验对列线图模型进行评价。结果:234例行ESD治疗的早期胃癌病人中共23例(9.8%)发生DPPB。多因素Logistic回归分析结果显示,活检次数≥3次(95%CI:2.482~20.424,P=0.000)、病变最大直径≥3 cm(95%CI:1.620~13.244,P=0.004)、浸润深度至黏膜下层(95%CI:1.421~10.536,P=0.008)、术中出血(95%CI: 1.160~11.300,P=0.027)是早期胃癌ESD后发生DPPB的独立危险因素。ROC曲线下面积(AUC)为0.838(95%CI:0.743~0.932)。校准曲线斜率接近1。Hosmer-Lemeshow拟合优度检验,χ2=3.328,P=0.505。结论:活检次数≥3次、病变最大直径≥3 cm、浸润深度至黏膜下层、术中出血是早期胃癌ESD后发生DPPB的独立危险因素,基于这4个独立危险因素构建的列线图模型可有效预测早期胃癌ESD后发生DPPB风险。
中图分类号:
龚婷婷, 钱爱华, 陈希. 个体化预测早期胃癌内镜黏膜下剥离术后迟发性出血风险的列线图模型构建[J]. 外科理论与实践, 2024, 29(03): 236-242.
Gong Tingting, Qian Aihua, Chen Xi. Construction of a Nomogram model for personalized prediction of the risk of delayed postoperative bleeding after endoscopic submucosal dissection for early gastric cancer[J]. Journal of Surgery Concepts & Practice, 2024, 29(03): 236-242.
表1
两组病人临床资料比较[n(%)]
Clinical characteristics | DPPB Group(n=23) | Non-DPPB Group(n=211) | χ2 value | P value | |
---|---|---|---|---|---|
Gender | Male | 14(60.9) | 120(56.9) | 0.135 | 0.713 |
Female | 9(39.1) | 91(43.1) | |||
Age(years) | ≥60 | 13(56.5) | 114(54.1) | 0.052 | 0.820 |
<60 | 10(43.5) | 97(45.9) | |||
BMI(kg/m²) | ≥24 | 9(39.1) | 78(36.9) | 0.042 | 0.838 |
<24 | 14(60.9) | 133(63.1) | |||
High blood pressure | Yes | 8(34.8) | 51(24.2) | 1.239 | 0.266 |
No | 15(65.2) | 160(75.8) | |||
Diabetes | Yes | 7(30.4) | 43(20.4) | 1.248 | 0.264 |
No | 16(69.6) | 168(79.6) | |||
Coronary heart disease | Yes | 9(39.1) | 47(22.3) | 3.237 | 0.072 |
No | 14(60.9) | 164(77.7) | |||
Smoking history | Yes | 12(52.2) | 91(43.1) | 0.689 | 0.407 |
No | 11(47.8) | 120(56.9) | |||
Alcohol intake history | Yes | 8(34.8) | 82(38.9) | 0.146 | 0.703 |
No | 15(65.2) | 129(61.1) | |||
Use of antithrombotic drugs | Yes | 6(26.1) | 17(8.1) | 7.607 | 0.006 |
No | 17(73.9) | 194(91.9) | |||
Lesion area | Upper 1/3 | 7(30.4) | 74(35.1) | 0.245 | 0.885 |
Middle 1/3 | 4(17.4) | 31(14.7) | |||
Lower 1/3 | 12(52.2) | 106(50.2) | |||
Morphology of lesions | 0-Ⅰp/0-Ⅰs | 1(4.4) | 34(16.1) | 2.364 | 0.307 |
0-Ⅱa-Ⅱc | 21(91.3) | 166(78.7) | |||
0-Ⅲ | 1(4.3) | 11(5.2) | |||
Number of biopsies(times) | ≥3 | 11(47.8) | 27(12.8) | 18.710 | 0.000 |
<3 | 12(52.2) | 184(87.2) | |||
Consolidated ulcer | Yes | 10(43.5) | 43(20.4) | 6.316 | 0.012 |
No | 13(56.5) | 168(79.6) | |||
Maximum diameter of lesion | ≥3 cm | 15(65.2) | 68(32.2) | 9.861 | 0.002 |
<3 cm | 8(34.8) | 143(67.8) | |||
Infiltration depth | T1a | 11(47.8) | 173(81.9) | 14.407 | 0.000 |
T1b | 12(52.2) | 38(18.1) | |||
Vascular invasion | No | 20(86.9) | 195(92.4) | 0.829 | 0.363 |
Yes | 3(13.1) | 16(7.6) | |||
Curative resection | Yes | 21(91.3) | 195(92.4) | 0.036 | 0.849 |
No | 2(8.7) | 16(7.6) | |||
Surgical time (h) | ≥1 | 14(60.9) | 109(51.7) | 0.706 | 0.401 |
<1 | 9(39.1) | 102(48.3) | |||
Intraoperative bleeding | ERB-c | 8(34.8) | 17(8.1) | 15.524 | 0.000 |
ERB-0 | 15(65.2) | 194(91.9) |
表2
多因素Logistic分析影响早期胃癌病人ESD后发生DPPB的危险因素
Factors | Description of assignment | B | Standard error | Wald | P value | OR | 95% confidence interval | |
---|---|---|---|---|---|---|---|---|
Lower limit | Upper limit | |||||||
Number of biopsies (1) | “<3”=0,“≥3”=1 | 1.963 | 0.538 | 13.328 | 0.000 | 7.120 | 2.482 | 20.424 |
Maximum diameter of lesion (1) | “<3 cm”=0,“≥3 cm”=1 | 1.533 | 0.536 | 8.176 | 0.004 | 4.631 | 1.620 | 13.244 |
Infiltration depth (1) | “T1a”=0,“T1b”=1 | 1.353 | 0.511 | 7.013 | 0.008 | 3.870 | 1.421 | 10.536 |
Intraoperative bleeding (1) | “No”=0,“Yes”=1 | 1.287 | 0.581 | 4.908 | 0.027 | 3.620 | 1.160 | 11.300 |
Constant | -4.254 | 0.582 | 53.418 | 0.000 | 0.014 |
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