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中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 282 -287. doi: 10.3877/cma.j.issn.1674-0793.2021.04.009

论著

进展期胃癌患者对新辅助化疗后病理完全缓解预测模型构建及价值
张云1, 张瑞奎1, 石娜1, 王晓娜2, 曹甜甜3, 赵冬雨1,()   
  1. 1. 300162 天津,武警特色医学中心特勤急救外科
    2. 100623 北京市普仁医院外科
    3. 100026 北京,武警北京总队医院内三科
  • 收稿日期:2021-02-24 出版日期:2021-08-03
  • 通信作者: 赵冬雨

Construction and validation of prediction model for pathological complete response of patients with advanced gastric cancer after neoadjuvant chemotherapy

Yun Zhang1, Ruikui Zhang1, Na Shi1, Xiaona Wang2, Tiantian Cao3, Dongyu Zhao1,()   

  1. 1. Department of Special Emergency Surgery, Special Medical Center of People’s Armed Police Force, Tianjin 300162, China
    2. Department of Surgery, Beijing Puren Hospital, Beijing 100623, China
    3. Department of No.3 Internal Medicine, Beijing General Team Hospital of People’s Armed Police Force, Beijing 100026, China
  • Received:2021-02-24 Published:2021-08-03
  • Corresponding author: Dongyu Zhao
引用本文:

张云, 张瑞奎, 石娜, 王晓娜, 曹甜甜, 赵冬雨. 进展期胃癌患者对新辅助化疗后病理完全缓解预测模型构建及价值[J/OL]. 中华普通外科学文献(电子版), 2021, 15(04): 282-287.

Yun Zhang, Ruikui Zhang, Na Shi, Xiaona Wang, Tiantian Cao, Dongyu Zhao. Construction and validation of prediction model for pathological complete response of patients with advanced gastric cancer after neoadjuvant chemotherapy[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(04): 282-287.

目的

分析进展期胃癌患者新辅助化疗后病理完全缓解(pCR)的影响因素,并构建pCR的列线图预测模型。

方法

收集2012年1月至2019年12月武警特色医学中心和武警北京总队医院收治的249例进展期胃癌患者的临床资料。利用Logistic回归分析确定影响新辅助化疗后pCR的危险因素。基于危险因素构建预测进展期胃癌患者新辅助化疗后pCR的列线图模型,并使用Bootstrap法进行内部验证。

结果

新辅助化疗后共33例(13.25%)发生pCR。多因素Logistic回归分析显示,癌胚抗原(CEA)水平升高、淋巴细胞比例升高、单核细胞计数低、肿瘤分化程度低是进展期胃癌患者新辅助化疗后pCR的影响因素。使用上述影响构建预测病理完全缓解发生的预测列线图,经Bootstrap法内部验证模型准确性,一致性指数C-index为0.819(95% CI:0.743~0.897)。

结论

本研究构建的预测进展期胃癌患者新辅助化疗pCR的列线图具有较高预测效能,值得临床推广。

Objective

To analyze the influencing factors of pathological complete response (pCR) in patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy, and to construct a nomogram prediction model of pCR.

Methods

The clinical data of 249 patients with AGC admitted to Special Medical Center of Armed Police Force and Beijing General Team Hospital of People’s Armed Police Force fromJanuary 2012 to December 2019 were collected. Logistic regression analysis was used to determine the risk factors of pCR after neoadjuvant chemotherapy. Based on the risk factors, a nomogram model was constructed to predict pCR in patients with AGC after neoadjuvant chemotherapy, and Bootstrap method was used for internal validation.

Results

A total of 33 cases (13.25%) developed pCR after neoadjuvant chemotherapy. Multivariate logistic regression analysis showed that higher CEA level, higher lymphocyte proportion, lower monocyte count and lower tumor differentiation were the influencing factors of pCR in patients with AGC after neoadjuvant chemotherapy. The accuracy of the model was verified by Bootstrap method, the C-index was 0.819 (95% CI: 0.743-0.897).

Conclusion

The nomogram constructed in this study can be used to predict the pCR of neoadjuvant chemotherapy in patients with AGC, which is worthy of clinical promotion.

表1 进展期胃癌新辅助化疗前资料对比
项目 未缓解组 缓解组 U/χ2 P
例数 216 33    
性别[例(%)]     1.291 0.256
  164(75.93) 28(84.85)    
  52(24.07) 5(15.15)    
年龄(岁) 58(51,65) 59(50,64) 0.577a 0.627
体质指数(kg/m2) 22.26±2.87 22.35±3.51 0.163 0.871
肿瘤位置[例(%)]     5.957 0.114
食管胃交界处 62(28.70) 12(36.36)    
  胃上1/3 24(11.11) 6(18.18)    
  胃中1/3 51(23.61) 2(6.06)    
  胃下1/3 79(36.57) 13(39.39)    
肿瘤分化程度[例(%)]     12.417 0.015
  良好 5(2.31) 4(12.12)    
  中分化 55(25.46) 11(33.33)    
  中-低分化 27(12.50) 7(21.21)    
  低分化 102(47.22) 10(30.30)    
  印戒细胞癌 27(12.50) 1(3.03)    
T分期[例(%)]     0.770 0.678
  T3 106(49.07) 18(54.55)    
  T4a 89(41.20) 11(33.33)    
  T4b 21(9.72) 4(12.12)    
N分期[例(%)]     0.780 0.377
  N0 5(2.31) 0(0.00)    
  N+ 211(97.69) 33(100)    
白细胞(×109/L) 6.49±1.92 5.87±1.48 1.775 0.077
红细胞(×1012/L) 4.41(3.92,4.73) 4.23(3.71,4.49) 1.823a 0.265
中性粒细胞(×109/L) 3.84(2.88,4.99) 3.07(2.59,3.60) 0.663a 0.591
中性粒细胞比例 0.63±0.12 0.59±0.09 1.836 0.068
淋巴细胞×(109/L) 1.62(1.23,2.07) 1.70(1.43,2.09) 2.922*a 0.124
淋巴细胞比例 0.25(0.22,0.35) 0.31(0.27,0.36) 9.897a 0.001
单核细胞(×109/L) 0.52(0.42,0.63) 0.45(0.33,0.56) 5.979a 0.015
单核细胞比例 0.08(0.06,0.11) 0.08(0.07,0.09) 1.775a 0.274
嗜酸性粒细胞(×109/L) 0.14(0.09,0.20) 0.15(0.07,0.21) 0.870a 0.512
嗜酸性粒细胞比例 0.02(0.01,0.03) 0.03(0.02,0.04) 3.791a 0.068
嗜碱性粒细胞(×109/L) 0.03(0.02,0.04) 0.04(0.02,0.05) 0.837a 0.524
嗜碱性粒细胞比例 0.01(0.00,0.01) 0.01(0.00,0.01) 1.723a 0.284
血红蛋白(g/L) 124(98.35,136.02) 119(83.11,135.17) 1.348a 0.368
血小板(×109/L) 260(213.08,331.25) 262(201.72,356.54) 0.152a 0.841
血尿酸(μmol/L) 344(261.90,415.32) 405.31(341.05,480.16) 8.894a 0.002
血肌酐(μmol/L) 77.32(64.88,89.01) 81.09(75.35,89.51) 2.535a 0.162
ALT(U/L) 13.79(9.91,19.02) 14.28(9.69,18.38) 0.039a 0.960
AST(U/L) 18.52(14.84,22.11) 17.02(13.39,22.31) 1.404a 0.354
r-GT(U/L) 18.84(14.59,30.61) 18.57(15.06,34.68) 0.395a 0.711
总蛋白(g/L) 67.95±6.48 70.11±6.29 1.790 0.075
ALB (g/L) 39.62±4.53 41.18±3.64 1.886 0.060
碱性磷酸酶(U/L) 85.57(68.73~100.52) 77.38(58.98,90.77) 2.526a 0.163
前白蛋白(g/L) 0.23±0.07 0.21±0.06 1.556 0.121
TBIL(μmol/L) 11.14(8.87,14.42) 10.51(6.88,16.17) 1.290a 0.383
DBIL(μmol/L) 2.23(1.70,3.13) 2.07(1.45,3.01) 1.791a 0.271
乳酸脱氢酶(U/L) 168(147.78,191.34) 169(149.25,197.53) 0.472a 0.674
胆固醇(mmol/L) 4.74±1.12 5.13±1.05 1.878 0.062
三酰甘油(mmol/L) 1.06(0.85,1.37) 1.17(0.83,1.49) 0.589a 0.622
高密度脂蛋白(mmol/L) 1.15(0.96,1.35) 1.23(1.04,1.43) 3.631a 0.076
低密度脂蛋白(mmol/L) 2.96(2.49,3.48) 3.27(2.90,3.53) 3.575a 0.079
C反应蛋白(mg/L) 2.36(0.93,9.68) 2.16(0.85,5.87) 1.167a 0.417
CA125(U/mL) 15.13(9.54,24.64) 12.45(7.45,21.03) 1.372a 0.362
CEA(μg/L) 2.52(1.37,4.92) 8.05(2.35,26.43) 8.862a 0.002
CA19-9(U/ml) 8.85(2.43,47.48) 15.29(4.43,34.21) 1.653a 0.298
CA153(U/ml) 7.38(5.27,10.75) 8.28(6.16,11.87) 1.582a 0.313
AFP(μg/L) 2.65(1.86,4.20) 2.77(2.04,10.76) 0.728a 0.565
化疗方案[例(%)]     3.286 0.070
  mFLOT 121(56.02) 24(72.73)    
  SOX/FOLFOX/XELOX 95(43.98) 9(27.27)    
化疗周期 4(4,5) 4(4,4) 0.192a 0.818
表2 两组进展期胃癌患者术后并发症比较[例(%)]
表3 可能影响病理完全缓解的多因素Logistic回归模型
图1 预测新辅助化疗后进展期胃癌患者病理完全缓解的列线图 CEA:<5 μg/L为1;≥5~10 μg/L为2;≥10~15 μg/L为3;≥15~20 μg/L为4;≥20~25 μg/L为5;≥25 μg/L为6;肿瘤分化程度:1为高分化;2为中分化;3为中-低分化;4为低分化;5为印戒细胞癌
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