摘要
目的:研究系统性炎症指标与宫颈癌淋巴结转移的关系,用R软件构建早期宫颈癌淋巴结转移的列线图模型。方法:回顾分析2015年1月至2022年7月于江南大学附属医院妇科行手术治疗的宫颈癌患者的临床资料,按术后病理分为淋巴结阳性组与淋巴结阴性组,比较两组术前系统性炎症指标的差异。通过单因素及多因素logistic分析宫颈癌淋巴结转移的影响因素,应用R软件建立早期宫颈癌淋巴结转移的预测模型,并通过内部及外部验证。结果:共纳入436例病例进行研究,238例作为训练集,198例作为外部验证集。训练集中淋巴结阳性组的术前白细胞、血小板、中性粒细胞、C-反应蛋白、纤维蛋白原以及中性粒细胞淋巴细胞比(NLR)、血小板淋巴细胞比(PLR)、纤维蛋白原白蛋白比(FAR)、C-反应蛋白白蛋白比(CAR)、全身免疫炎症指数(SII)显著高于淋巴结阴性组,差异有统计学意义(P<0.05);淋巴结阴性组患者的淋巴细胞单核细胞比(LMR)显著高于淋巴结阳性组(P<0.05)。单因素分析证实,NLR、PLR、CAR、SII以及肿瘤直径、浸润深度与宫颈癌患者淋巴结转移有关(P<0.05)。多因素logistic回归分析显示,浸润深度、PLR和SII是早期宫颈癌患者淋巴结转移的独立危险因素(P<0.05)。绘制ROC曲线结果显示,训练集AUC为0.805(95%CI为0.750~0.859),外部验证集AUC为0.819(95%CI为0.732~0.907)。校准曲线显示,校准预测曲线与理想曲线曲度一致,列线图预测的淋巴结转移概率与实际情况相符(训练集C-index:0.805,外部验证C-index:0.819)。结论:应用系统性炎症指标所构建的宫颈癌淋巴结转移预测模型与实际发生情况相符,有助于妇瘤科医师对宫颈癌患者实施盆腔淋巴结清扫术时做出正确的评估。
Objective:To study the relationship between systemic inflammation and lymph node metastasis of cervical cancer,and to establish a prediction model of lymph node metastasis of cervical cancer with R software.Methods:The clinical data of patients with cervical cancer treated surgically in the Department of Gynecology,Affiliated Hospital of Jiangnan University,from January 2015 to July 2022 were retrospectively analyzed.According to the postoperative pathology,they were divided into lymph node metastasis group and lymph node negative group.The differences of preoperative systemic inflammation indexes between the two groups were compared.Univariate analysis and multivariate logistic regression were used to analyze the influencing factors of lymph node metastasis of cervical cancer.The nomogram model for predicting lymph node metastasis of early cervical cancer was constructed by R software,and internal validation was carried out.Results:A total of 436 cases were included in the study,238 cases were used as the training set,and 198 cases were used as the external verification set.The preoperative leukocyte,fibrinogen,neutrophil,platelet,C-reactive protein and neutrophil lymphocyte ratio(NLR),platelet lymphocyte ratio(PLR),fibrinogen albumin ratio(FAR),C-reactive protein albumin ratio(CAR),and systemic immune inflammation index(SII)in the positive lymph node training group were significantly higher than those in the negative lymph node training group(P<0.05).Lymphocyte monocyte ratio(LMR)in patients with negative lymph nodes was significantly higher than that in patients with positive lymph nodes(P<0.05).Univariate analysis confirmed that NLR,PLR,CAR,SII,tumor diameter and invasion depth were related to lymph node metastasis in cervical cancer patients(P<0.05).Multivariate logistic regression analysis showed that depth of invasion,PLR and SII were independent risk factors for lymph node metastasis in patients with early cervical cancer(P<0.05).The ROC curve results showed that the AUC of the training set was 0.805(95%CI:0.750~0.859),and the AUC of the external verification set was 0.819(95%CI:0.732~0.907).The calibration curve showed that the calibration prediction curve was consistent with the ideal curve,and the lymph node metastasis probability predicted by nomogram was consistent with the actual situation(training set C-index:0.805,external verification C-index:0.819).Conclusion:The nomograph model of systemic inflammatory indicators predicting lymph node metastasis of cervical cancer has good consistency,which is helpful for gynecologists to make a correct evaluation of pelvic lymph node dissection in patients with cervical cancer.
作者
郭曲
许希中
李卫民
张振宇
毛玉荣
董若凡
Guo Qu;Xu Xizhong;Li Weimin(Department of Gynecology,Affiliated Hospital of Jiangnan University,Wuxi 214063;Ultrasonography Department,Affiliated Hospital of Jiangnan University,Wuxi 214063)
出处
《现代妇产科进展》
CSCD
北大核心
2022年第12期890-895,共6页
Progress in Obstetrics and Gynecology
关键词
宫颈癌
淋巴结转移
系统性炎症指标
列线图
Cervical cancer
Lymph node metastasis
Systemic inflammatory index
Nomograph
