摘要
目的研究术前与胰腺导管内乳头状粘液性肿瘤(IPMN)恶变相关的危险因素,构建IPMN恶变风险预测模型并评价其预测性能及临床价值。方法采用回顾性病例对照研究方法,筛选后纳人2015年1月至2021年12月安徽医科大学第一附属医院收治的IPMN患者98例,定为训练组;纳人同期安徽医科大学第二附属医院及中国科学技术大学第一附属医院IPMN患者52例,定为验证组。利用单因素和多因素logistic回归分析在训练组中筛选出与IPMN恶变相关的危险因素,构建列线图模型,基于验证组数据对模型进行外部验证。通过C指数、校准曲线和受试者工作特征曲线(receiver operating characteristic,ROC)对模型进行评价。结果训练组logistic回归分析提示主胰管扩张≥1Omm、强化附壁结节、肿瘤最大直径≥30mm及血清CA19-9升高是IPMN恶变的独立危险因素,纳人这些因素构建列线图预测模型。训练组C指数为0.834(95%CI:0.744~0.924),验证组C指数为0.847(95%CI:0.733~0.960)。绘制R0C曲线,约登指数最大时的模型总分最佳截止值为124.0分,此时对应的敏感度和特异度分别为82.8%和71.0%。校准曲线表现出较好的拟合度,表明该模型具有良好的预测精准度和灵敏度。结论主胰管扩张≥10mm、强化附壁结节、肿瘤最大直径≥30mm及血清CA19-9升高是IPMN恶变的独立危险因素,基于此构建的IPMN恶性风险预测模型具有较高的临床价值,可为临床诊疗方案的制定提供参考。
Objective To study the risk factors associated with malignant transformation of intraductal papillary mucinous neo-plasms of pancreas(IPMN)before operation,construct the risk prediction model of malignant transformation of IPMN,and evaluate its predictive performance and clinical value.Methods A retrospective case-control study was used to select 98 patients with IPMN who were admitted to the First Affiliated Hospital of Anhui Medical University from January 2015 to December 2021 and assigned as the training group.Fifty-two IPMN patients from the Second Affiliated Hospital of Anhui Medical University and the First Affiliated Hospi-tal of University of Science and Technology of China during the same period were included as the verification group.Univariate and multivariate logistic regression analysis was used to screen out the risk factors related to IPMN malignant transformation in the training group,build a nomogram model,and conduct external verification of the model based on the data of the verification group.C index,calibration curve and receiver operating characteristic(ROC)were used to evaluate the model.Results Logistic regression analysis in the training group suggested that Dilation of main pancreatic duct≥10mm,enhancement of mural nodules,maximum tumor diameter≥3Omm and elevation of serum CA19-9 were independent risk factors for malignant transformation of IPMN,and these factors were in-cluded in the construction of a nomogram prediction model.The C index of the training group was 0.834(95%CI:0.744~0.924),and that of the verification group was 0.847(95%CI:0.733~0.960).When the ROC curve is drawn,the optimal cut-off value of the total score of the model is 124.O points when the Jorden index is maximum,and the corresponding sensitivity and specificity are 82.8%and 71.0%,respectively.The calibration curve shows a good degree of fit,which indicates that the model has good prediction accuracy and sensitivity.Conclusions Dilation of main pancreatic duct≥10mm,enhancement of mural nodules,maximum tumor diameter≥30mm and elevation of serum CA19-9 are independent risk factors for malignant degeneration of IPMN.The malignant risk prediction model of IPMN built on this basis has high clinical value and can provide references for the formulation of clinical diagnosis and treatment plans.
作者
刘学谦
蒋东
贺良
刘振
赵义军
刘付宝
LIU Xue-qian;JIANG Dong;HE Liang(Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,China;Department of General Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefe,China)
出处
《肝胆外科杂志》
2024年第2期93-97,125,共6页
Journal of Hepatobiliary Surgery
基金
2021年度安徽高校自然科学研究项目(KJ2021ZD0021)。
关键词
胰腺导管内乳头状粘液性肿瘤
预测模型
列线图
恶变风险
intraductal papillary mucinous neoplasms of pan-creas
prediction model
nomogram
malignant risk
