摘要
【目的】构建复发性鼻咽癌患者经鼻内镜手术治疗后再次复发的预测模型。【方法】回顾性分析2020年4月至2023年4月在本院行经鼻内镜手术治疗的133例鼻咽癌复发患者的临床资料。所有患者术后随访2年,根据术后是否复发分为复发组和无复发组。采用单因素及多因素分析复发性鼻咽癌患者术后再次复发的影响因素,并以此构建Nomogram列线图模型预测复发性鼻咽癌患者术后再次复发风险;采用受试者工作特征(ROC)曲线下面积(AUC)评估预测模型对复发性鼻咽癌患者术后再次复发的预测效能。【结果】复发性鼻咽癌患者术后2年内复发率为32.33%(43/133)。单因素分析结果显示:复发组临床分期为Ⅲ~Ⅳ期占比、系统性免疫炎症指数(SII)≥445.3占比、低分化程度占比、淋巴结转移占比、EB病毒DNA载量为阳性占比均高于无复发组,白蛋白水平≥35 g/L占比低于无复发组(P<0.05)。二元Logistic回归分析结果显示:临床分期高、SII高、EB病毒DNA载量为阳性是复发性鼻咽癌患者术后再次复发的独立危险因素(P<0.05),白蛋白水平高是复发性鼻咽癌患者术后再次复发的独立保护因素(P<0.05)。基于上述影响因素构建列线图预测模型,经Bootstrap内部验证显示:C-index指数为0.852,预测患者术后复发的校正曲线趋近于理想曲线(P>0.05)。ROC曲线结果显示:列线图模型预测复发性鼻咽癌患者术后再次复发的敏感度为88.40%、特异性为87.80%,AUC为0.883。【结论】临床分期高、SII高、EB病毒DNA载量为阳性是复发性鼻咽癌患者术后再次复发的独立危险因素,白蛋白水平高是复发性鼻咽癌患者术后再次复发的独立保护因素。基于上述影响因素建立的列线图风险预测模型可较好评估复发性鼻咽癌患者术后再次复发风险。
【Objective】To construct a prediction model for recurrence after transnasal endoscopic surgery in patients with recurrent nasopharyngeal carcinoma(NPC).【Methods】The clinical data of 133 patients with recurrent NPC who underwent transnasal endoscopic surgery in our hospital from April 2020 to April 2023 were retrospectively analyzed.All patients were followed up for 2 years and divided into recurrence group and non-recurrence group according to postoperative recurrence status.Univariate and multivariate analyses were used to identify influencing factors of postoperative recurrence,and a Nomogram model was constructed to predict recurrence risk.The predictive efficacy was evaluated by the area under the receiver operating characteristic(ROC)curve(AUC).【Results】The 2-year postoperative recurrence rate was 32.33%(43/133).Univariate analysis showed that the recurrence group had higher proportions of clinical stageⅢ-Ⅳ,systemic immune-inflammation index(SII)≥445.3,poor differentiation,lymph node metastasis,and positive EB virus DNA load,and lower proportion of albumin level≥35 g/L(P<0.05).Binary Logistic regression showed that high clinical stage,high SII,and positive EB virus DNA load were independent risk factors for postoperative recurrence(P<0.05),while high albumin level was an independent protective factor(P<0.05).The Nomogram model constructed based on these factors had a C-index of 0.852 by Bootstrap internal validation,with the calibration curve approaching the ideal curve(P>0.05).ROC curve showed the model had a sensitivity of 88.40%,specificity of 87.80%,and AUC of 0.883 for predicting recurrence.【Conclusion】High clinical stage,high SII,and positive EB virus DNA load are independent risk factors for postoperative recurrence,while high albumin level is an independent protective factor.The Nomogram model based on these factors can effectively assess the recurrence risk of NPC patients after surgery.
作者
王晓燕
代晨曦
牛庆华
胡莹莹
WANG Xiaoyan;DAI Chenxi;NIU Qinghua(Department of Otorhinolaryngology,Lankao First Hospital,Lankao Henan 475300)
出处
《医学临床研究》
2025年第6期1019-1022,1026,共5页
Journal of Clinical Research
关键词
鼻咽肿瘤
复发
内窥镜检查
外科手术
Nasopharyngeal Neoplasms
Recurrence
Endoscopy
Surgical Procedures,Operative
